Is three-dimensional ultrasound or magnetic resonance imaging more effective in the diagnosis of congenital uterine anomalies?

Manjit Bual – University Hospitals of Derby and Burton NHS Foundation Trust


Congenital uterine anomalies (CUAs) are embryological malformations of the uterus. Infertility, recurring miscarriage and fetal intrauterine growth restriction are common symptoms of CUAs. Accurate diagnosis of the type of CUA is vital for patient management. The Royal College of Obstetrics and Gynaecologists (RCOG) considers three-dimensional transvaginal ultrasound (3DTVS) to be the gold standard for diagnosing and classifying CUAs because it is more reproducible and less invasive than other imaging and surgical diagnostic modalities (RCOG, 2019). Trust A currently only indicates Magnetic Resonance Imaging (MRI) when diagnosing CUAs. However, 3DTVS may provide a more accessible and cost-effective pathway for patients.


A systematic literature search has been conducted using the seven most relevant healthcare databases: Cinahl Complete, Directory of Open Access Journals (DOAJ), EBSCO Medical Databases, Embase, Medline, Science Direct and Scopus. Boolean search operators were utilised and results were refined to the past six years (2016–2022) to increase relevance to practice and generalizability. This resulted in three primary articles.


Three-dimensional ultrasound is a viable alternative to pelvic MRI; it is less expensive than MRI and patients tolerate it better. 3DTVS has been reported to have strong diagnostic agreement with MRI, with one study suggesting that 3D ultrasound is superior in identifying and categorising CUAs. The literature review demonstrated that the RCOG's recommended practice is substantiated by current research.

Relevance to practice

By utilising 3DTVS, local gynaecology services can assist, manage and share the workload of the imaging department, making these services more beneficial for both the patient and the practitioner. Sonographer progression would be aided by increased work responsibilities.


Trust A should integrate 3D ultrasound into the CUA patient pathway to improve patient care by supplying more accurate diagnostic equipment. More research on larger cohorts with more challenging CUAs is still required.

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