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.