الفهرس 
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Abstract
CSD is related to a lot of gynecological symptoms. postmenstrual spotting is the most prevalent symptom related to cesarean section scar defects due to blood retention at the CSD and poor uterine contractility.
Transvaginal ultrasound and sono hystrography are the most commonly used methods for imaging of CSD.
This is a prospective cross-sectional study conducted on 62 patients sub-grouped into two equal groups according to the presence of postmenstrual spotting to assess the role of MRI in estimating the cesarean section scar defect and its relation with postmenstrual spotting.
We found that the niche length, depth, width, volume as well as the minimal residual myometrial thickness (RMT) and the relative change percentage in RMT in correlation with the posterior uterine wall are significantly related to the development of postmenstrual spotting.
The most important predictors for the development of postmenstrual spotting in patients with CSD are scar volume > 0.15 cm3, scar depth > 7.4 mm, and width > 12.8 mm.
Automatically calculated volume from 3D images generated by the 3D slicer software program is more reliable in estimating the scar volume in irregularly shaped scar defects.
Conclusion
• MRI is a reliable non-invasive method for assessment of CS scar defect either using manually or automatically calculated CSD volumes.
• CSD volume, depth, and width are predictor factors for postmenstrual spotting in patients with CSD.
Recommendations
On the base of this study we recommend:-
a. Use of MRI as a non-invasive, non-operator-dependent method for evaluation of cesarean section scar defects in patients with postmenstrual spotting.
b. CSD volume, depth, and width should be included in the standard MRI report of the pelvic organs.
c. Performing other studies on the relation of cesarean section scar defects characters imaged by MRI and other gynecological symptoms like secondary infertility and chronic pelvic pain.
d. Performing a comparative study with a larger sample volume between the MRI and sono hysterography in imaging of cesarean section scar defects for developing a proper scoring system .
e. Use of 3D slicer software program in assessing CSD volume.