Evaluation of the uterine cavity by magnetic resonance imaging, three dimensional hysterosonography and diagnostic hysteroscopy in women with pre- and post-menopausal bleeding

Objective: To compare the diagnostic potential of magnetic resonance imaging (MRI), three dimensional (3D) hysterosonography and diagnostic hysteroscopy in evaluation of the uterine cavity in women with premenopausal and postmenopausal bleeding. Design: Comparative study. Setting: Zagazig University hospital. Materials and methods: 30 patients with premenopausal bleeding and 30 patients with postmenopausal bleeding scheduled for hysterectomy were submitted to MRI, 3D hysterosonography and hysteroscopy to evaluate the endometrial cavity. Results were compared with histopathologic examination at hysterectomy (the gold standard). Results: In the premenopausal group; the sensitivity of MRI was 71.43%, 3D hysterosonography 85.71% and hysteroscopy 80.95%, the specificity of MRI was 55.56%, 3D hysterosonography 66.67% and hysteroscopy 88.89% and the degree of agreement with histopathology was 0.47 for MRI, 0.65 for 3D hysterosonography and 0.73 for hysteroscopy (P =.000, 0.000 and 0.000, respectively). In the postmenopausal group; the sensitivity of MRI was 88.24%, 3D hysterosonography 88.24% and hysteroscopy 88.24%, the specificity of MRI was 69.23%, 3D hysterosonography 84.61% and hysteroscopy 84.61% and the degree of agreement with histopathology was 0.60 for MRI, 0.72 for 3D hysterosonography and 0.73 for hysteroscopy (P =.000, 0.000 and 0.000, respectively) and for both groups; the sensitivity of MRI was 78.75%, 3D hysterosonography 86.84% and hysteroscopy 84.21%, the specificity of MRI was 63.64%, 3D hysterosonography 77.27% and hysteroscopy 86.36% and the degree of agreement with histopathology was 0.54 for MRI, 0.69 for 3D hysterosonography and 0.73 for hysteroscopy (P =.000, 0.000 and 0.000, respectively). Conclusions: Hysteroscopy is the best method in evaluation of uterine cavity in women with premenopausal and post menopausal bleeding; but more invasive. MRI is the best method for detection of submucous myoma especially when the cavity is large or tumor is small. (C) 2014 Production and hosting by Elsevier B.V. on behalf of Middle East Fertility Society.