Differentiating between septate and bicornuate uterus: bi-dimensional and 3-dimensional power Doppler findings

Study objective: To assess if any difference could be found in uterine vascularization between septate and bicornuate uterus.

Design: Pilot study (Canadian Task Force classification II-2).

Setting: University hospital infertility clinic.

Patients: One hundred nine women with complete duplication of the uterine cavity. All had already received the final diagnosis of the type of uterine malformation, either septate uterus or bicornuate uterus, via diagnostic hysteroscopy and laparoscopy. Another group of 10 patients with uterine anomalies and affected by ovarian mass were also evaluated via intravenous contrast medium-enhanced ultrasound examination.

Interventions: Patients were evaluated using 2-dimensional and 3-dimensional power Doppler imaging of the uterus.

Measurements and main results: Seventy-three patients with septate uterus, with or without cervical and vaginal duplication, and 36 patients with bicornuate uterus were selected for inclusion in the study. Irregular vascular networks were detected between the 2 hemicavities in the patients with septate uterus. All bicornuate uteri showed a peculiar vascular network between the 2 hemicavities: the main recognizable vessels formed a network depicting the Greek letter γ at the level of the uterine midline. Detection of the γ sign can be used to differentiate septate from bicornuate uterus. This finding was also confirmed in patients who underwent intravenous contrast medium-enhanced ultrasound examination.

Conclusions: power Doppler provides a new and uninvasive tool for differentiation of septate from bicornuate uterus.