الفهرس 
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Abstract
Abnormal uterine bleeding is one of the commonest female complains in all the different age groups. Reaching the proper diagnosis is a challenge and it is important to limit the diagnostic methods as much as possible to avoid unnecessary interventions and costs.
It should always be considered that AUB could be due to causes other than local gynecological causes, so excluding these causes is important to reach the appropriate plan for management.
Ideally, a non-invasive investigation is preferred over an invasive one and also an economical investigation preferred over an expensive one; this applies equally to affluent countries and third world, that’s why ultrasonography by any modality is considered to a non-invasive procedure to investigate uterine lesions rather than hysteroscopy which is a highly invasive one with a high cost.
Hysteroscopy is a valuable method for diagnosing AUB due to local uterine pathology and although many other alternatives are introduced in the past decades but still hysteroscopy is the gold standard.
Although being the gold standard it has its own drawbacks which limits its use, being an invasive procedure make it difficult to use it liberally and limits its use for selected cases.
At present, real-time 2-D US makes it possible for physicians to make important contributions to patient management. However, there are occasions when it is difficult to develop a three-dimensional impression of the patient anatomy, particularly with curved structures. When there is a subtle lesion in an organ, when a mass distorts the normal anatomy, or when there are tortuous vessels or structures not commonly seen that can be difficult to visualize with 2-DUS methods. The typical approach to overcome this problem is to scan repeatedly through the region of interest to clarify the exact relationships. Complex cases often make it difficult even for specialists to understand three-dimensional anatomy based on two-dimensional images and can be time-consuming. Abnormalities may be difficult to demonstrate with 2-DUS because of the particular planes that must be imaged to develop the entire three- dimensional impression.
Introduction of 3-D ultrasound offered a new imaging technique superior to others and allows better visualization of the uterine anatomy.
3-D SIS is introduced as an alternative to other invasive methods for diagnosing intrauterine pathology, and it was clear that 3-D SIS has the ability to diagnose minor local uterine lesions that could be missed in other conventional imaging methods.
In the present study,fifty (50) patients with perimenopausal bleeding attending to the outpatient clinic to Obstetrics and Gynecology Department, Menoufiya University Hospital from June 2009 to May 2010.
All patients had 2-D ultrasound,3-D ultrasound and 3-dimensional hysterosonography preceded by a setting of diagnostic hysteroscopy. The aim was to compare the obtained results of the 2-D US, 3-D US and 3-D hysterosonography procedure to the results of hysteroscopy, considered as a gold standard test.
It is found that there is a good overall agreement between 3-D US, 3-D SIS and hysteroscopy as structural abnormalities affecting the uterine cavity were detected with similar accuracy using 3-D SIS and hysteroscopy.
However, the advantages of 3-D SIS reside in its ability to register all three imaging planes simultaneously, to reconstruct new planes which are otherwise not visible, to demonstrate area that can’t be visualised by other techniques even hysteroscopy as endometrial-myometrial interface. It provides the possibility to review patient data and images at any time even after she has left the clinic that gives a better chance for getting to the accurate diagnosis.
3-D SIS not only proves to be at least as good as hysteroscopy in detecting intrauterine cavitary abnormalities, but it has the superior hand as being a minimally invasive procedure, extremely accurate, feasible, with relatively few contraindications,well tolerated, rapid and can be performed as an outpatient setting with no need of anesthesia.
Three dimensional hysterosonography also proves to be a less minimally invasive procedure compared to hysteroscopy as the former allows the use of (paediatricfollycatheter)(small diameter). Hysteroscopy in the other hand shows theusage of scopes with external sheaths of relatively large diameters (5 mm).
With all what is mentioned above, it should be reconsidered: does hysteroscopy still considered the gold standard test in detecting uterine lesions? And can 3-dimensional hysterosonography be its suitable alternative diagnostic tool for intracaviatary uterine lesions?