The objective of this study was to investigate the usefulness of transvaginal color Doppler and three-dimensional power Doppler ultrasonography for the assessment of endometrial receptivity. A total of 89 patients undergoing in vitro fertilization procedures were evaluated for endometrial thickness and volume, endometrial morphology, and subendometrial perfusion on the day of embryo transfer. Neither the volume nor the thickness of the endometrium on the day of embryo transfer had a predictive value for conception during in vitro fertilization cycles (P > .05). Patients who became pregnant were characterized by a significantly lower resistance index, obtained from subendometrial vessels by transvaginal color Doppler ultrasonography (resistance index = 0.53 +/- 0.04 versus 0.64 +/- 0.04, pregnant versus not pregnant, respectively; P < .05), and a significantly higher flow index (13.2 +/- 2.2 versus 11.9 +/- 2.4; P < .05), as measured by a three-dimensional power Doppler histogram. No difference was found in the predictive value of scoring systems analyzing endometrial thickness and volume, endometrial morphology, and subendometrial perfusion by color Doppler and three-dimensional power Doppler ultrasonography. The high degree of endometrial perfusion shown by color Doppler ultrasonography and on three-dimensional power Doppler histograms on the day of embryo transfer can indicate a more favorable endometrial milieu for successful in vitro fertilization.

Objective. To study a spectrum of systems (two-dimensional transvaginal, transvaginal color Doppler, three-dimensional, three-dimensional power Doppler, and contrast-enhanced three-dimensional power Doppler sonography) for preoperative evaluation of pelvic tumors. Methods. Two hundred ninety-two patients were evaluated by the 5 complementary methods in preoperative sonographic assessments. We examined adnexal and endometrial morphology, thickness, and volume by two-and three-dimensional sonography and analyzed blood flow by transvaginal color, pulsed Doppler, and three-dimensional power Doppler sonography in all examined patients. In 89 patients with complex adnexal lesions of uncertain malignancy, contrast-enhanced three-dimensional power Doppler sonography was performed. Results. Morphologic assessment by three-dimensional sonography yielded additional information in 58% of cases compared with two-dimensional sonography. Furthermore, this modality was superior to two-dimensional sonography in accurate depiction and diagnosis of 2 cases of fallopian tube carcinoma. Combined morphology and vascular indexing reached sensitivity of 97% and specificity of 99%. Endometrial volume in patients with malignant disease was significantly different (28.2 ± 0.02 cm 3 ) from that in those who had hyperplasia (7.81 ± 0.03 cm ). With combined morphologic and threedimensional power Doppler examination of endometrial lesions, sensitivity and specificity reached 89% and 97%, respectively. Conclusions. Combined morphologic and vascular imaging improves preoperative assessment of gynecologic tumors. Key words: gynecologic malignancy; morphology; vascularity; three-dimensional sonography; preoperative evaluation. espite numerous efforts and innovative approaches, an effective method for early detection of ovarian cancer, as well as accurate and reliable preoperative evaluation of adnexal and endometrial lesions, has yet not been found. At this time, the best strategy includes a combination of several noninvasive diagnostic tests that are performed in the setting of a clinical trial. Among these, sonography has no known hazards. Malignant adnexal tumors could be detected by changes in ovarian volume or morphology, or both.1 Although, no universally accepted criteria exist for the sonographic diagnosis of ovarian cancer, scoring systems featuring explicit and reproducible criteria have been developed. [2][3][4][5]

Three-dimensional (3D) ultrasound plays an important role in obstetrics, predominantly for assessing fetal anatomy. Presenting volume data in a standard anatomic orientation valuably assists both ultrasonographers and pregnant patients to recognize the anatomy more readily. Three-dimensional ultrasound is advantageous in studying normal embryonic and/or fetal development, as well as providing information for families at risk for specific congenital anomalies by confirming normality. This method offers advantages in assessing the embryo in the first trimester due to its ability to obtain multiplanar images through endovaginal volume acquisition. Rotation allows the systematic review of anatomic structures and early detection of fetal anomalies. Three-dimensional ultrasound imaging in vivo compliments pathologic and histologic evaluation of the developing embryo, giving rise to a new term: 3D sonoembryology. Rapid technological development will allow real-time 3D ultrasound to provide improved and expanded patient care on the one side, and increased knowledge of developmental anatomy on the other.

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