T-shaped dysmorphic uterus: discrepancies between current 3D-ultrasound diagnostic criteria.

Abstract

Purpose: Review and compare current classifications for diagnosing T-shaped uterus using three-dimensional transvaginal ultrasound (3D-TVS) measurements, identifying measurements that best correlate with the diagnosis.

Methods: This retrospective cohort study analyzed diagnostic measurements in patients with T-shaped uterus who underwent 3D-TVS at the University of Rome 'Tor Vergata' from 2016 to 2022. Of 7588 patients, four sonographers re-evaluated 3D-TVS images of 72 initially diagnosed cases. Uterine morphology was assessed in the coronal plane by measuring fundal cavity width (R0), corpus-isthmic cavity width (Wi), lateral indentation angle (AI), lateral bulging (LB), T-angle (AT), fundal/isthmic cavity width ratio (R0/Wi), and the length of intracavitary line parallel to interostial line (R10). All cases were confirmed by hysteroscopy, excluding ambiguous findings.

Results: Of 72 initially evaluated patients, 50 met the inclusion criteria for final analysis. These patients had consistent 3D-TVS diagnoses from four sonographers and hysteroscopic confirmation from two experts. The combination of three CUME criteria (AT ≤ 40°, AI ≤ 130°, LB ≥ 7 mm) identified only 8% of T-shaped uteri. Notably, 30 patients (60%) had an R10 measurement of ≤ 10 mm. In addition, 31 uteri (62%) met all three criteria: LB ≥ 5 mm, AI ≤ 140°, and R0/Wi ≥ 5. Overall, 48 uteri (96%) satisfied at least two criteria. The study concluded that LB, R10, and R0/Wi are independent predictors of T-shaped uterus.

Conclusions: Significant discrepancies exist among current classifications for diagnosing T-shaped uterus. This study identified LB, R10, and R0/Wi as key parameters for accurate diagnosis. These measurements provide a precise and objective approach, aiding in the evaluation of the anomaly's impact on reproductive outcomes and the benefits of hysteroscopic treatment.