The Value Of Combined Transvaginal Two-dimensional And Three-dimensional Ultrasound In Diagnosis Of Previous Cesarean Scar Diverticulum

Objective To explore the value of transvaginal two-dimensional combined with three-dimensional ultrasonography in the diagnosis of Previous Cesarean Scar Diverticulum(PCSD)after cesarean section.Methods From April 2017 to May 2018,152 patients with suspected clinical Previous Cesarean Scar Diverticulum(PCSD)came to our department for ultrasonography.All patients underwent transvaginal two-dimensional and three-dimensional ultrasonography to observe the healing of uterine incision.If diverticulum was found in the examination,the diverticulum depth,height,width and the thickness of anterior remnant uterine myometrium were measured,the diverticulum shape type was described,and the volume of the diverticulum was measured by three-dimensional ultrasound volume imaging.The value of combined transvaginal two-dimensional and three-dimensional ultrasonography in the diagnosis of previous cesarean scar diverticulum was discussed based on the results of hysteroscopy.Results Final 96 patients were included in the study.There were 65 cases of PCSD diagnosed by transvaginal two-dimensional ultrasonography,82 cases of PCSD diagnosed by transvaginal three-dimensional ultrasonography,and 88 cases of PCSD diagnosed by hysteroscopy.Based on the results of hysteroscopy,the diagnostic accuracy of PCSD by transvaginal three-dimensional ultrasonography(93.18%,82/88)was significantly higher than that by transvaginal two-dimensional ultrasonography(73.86%,65/88)(P<0.05).There was significant difference in the measurement of residual uterine myometrium thickness in front of PCSD by two-dimensional and three-dimensional transvaginal ultrasound(P<0.05),but there was no significant difference in the measurement of PCSD depth,height and width(P>0.05).The accuracy of transvaginal three-dimensional ultrasonography in diagnosis of light diverticulum was 89.19%(33/37),significantly higher than that of transvaginal two-dimensional ultrasonography 51.35%(19/37)(P<0.05),and the diagnostic consistency was poor of the two methods(K=0.227,P=0.030);The accuracy of transvaginal three-dimensional ultrasonography in the diagnosis of medium-sized diverticulum was 93.10%(27/29),higher than that of transvaginal two-dimensional ultrasonography 82.75%(24/29)(P>0.05).There was no significant difference between them,and the consistency of diagnosis was acceptable(K=0.525,P=0.001);The accuracy of transvaginal two-dimensional and three-dimensional ultrasonography in the diagnosis of severe diverticulum was 100%,and the diagnostic consistency was good.In this study,PCSD sonographic features were mainly manifested as fissure-like fluid dark area in 20 cases,wedge-like and triangular-like dark area in 43 cases,funnel-like dark area in 11 cases,and circular-like dark area in 8 cases.35 patients were followed up for surgical treatment,including 4 patients with light diverticulum underwent hysteroscopic cesarean incision diverticulum resection,4patients with medium diverticulum underwent laparoscopic cesarean scar diverticulum repair,14 patients with medium diverticulum underwent transvaginal cesarean scar diverticulum repair,13 patients with severe diverticulum underwent transvaginal cesarean scar diverticulum repair,and the clinical symptoms of the patients were significantly improved.Conclusions The combined application of transvaginal two-dimensional and three-dimensional ultrasound can evaluate PCSD more comprehensively(diverticulum size,anterior residual uterine myometrium thickness,myometrial blood flow,diverticulum volume,periuterine condition),and improve the diagnostic accuracy of PCSD,especially for the diagnosis of light diverticulum and the measurement of uterine residual myometrium.It makes up for the deficiency of transvaginal two-dimensional ultrasound,and provides more comprehensive reference information for clinical diagnosis and evaluation of PCSD.