The technique involves transcervical injection of sterile fluid, such as saline, in combination with routine TVUS [10,49]. Although some authors describe transcervical injection of gel [37], sterile saline is currently the accepted standard endometrial contrast agent [49]. The literature supports the use of US sonohysterography as an examination to further characterize endometrial observations on TVUS [48-51]. US sonohysterography can help distinguish between leiomyomas and endometrial polyps with pooled accuracies of 97% [51]. With the sonohysterographic features of an intact myometrial- endometrial interface, a single vessel, an acute angle with the endometrium, and a homogenous echogenicity, the likelihood ratio of an endometrial polyp is optimized, whereas the combined features of absent endometrial- myometrial interface, arborized vascular pattern, obtuse angle with the endometrium, and a heterogeneous echogenicity maximizes the likelihood ratio of an intracavitary or submucosal leiomyoma [50]. Despite its ability to differentiate polyps and leiomyomata, sonohysterography cannot distinguish between benign endometrial pathology and endometrial cancer with a high degree of certainty, and endometrial sampling or direct visualization with hysteroscopy is recommended in women with suspected endometrial pathology [10,50,51]. In the setting of focal endometrial pathology, an accurate description of the location of the abnormality may direct hysteroscopic resection. US sonohysterography is helpful to distinguish between focal or diffuse pathology in the setting of a postmenopausal woman with AUB and a thickened endometrium on TVUS [58]. However, US sonohysterography cannot distinguish between benign endometrial pathology and endometrial cancer with a high degree of certainty, and endometrial sampling or direct visualization with hysteroscopy is recommended in women with suspected endometrial pathology [10].
Abnormal Uterine Bleeding. The technique involves transcervical injection of sterile fluid, such as saline, in combination with routine TVUS [10,49]. Although some authors describe transcervical injection of gel [37], sterile saline is currently the accepted standard endometrial contrast agent [49]. The literature supports the use of US sonohysterography as an examination to further characterize endometrial observations on TVUS [48-51]. US sonohysterography can help distinguish between leiomyomas and endometrial polyps with pooled accuracies of 97% [51]. With the sonohysterographic features of an intact myometrial- endometrial interface, a single vessel, an acute angle with the endometrium, and a homogenous echogenicity, the likelihood ratio of an endometrial polyp is optimized, whereas the combined features of absent endometrial- myometrial interface, arborized vascular pattern, obtuse angle with the endometrium, and a heterogeneous echogenicity maximizes the likelihood ratio of an intracavitary or submucosal leiomyoma [50]. Despite its ability to differentiate polyps and leiomyomata, sonohysterography cannot distinguish between benign endometrial pathology and endometrial cancer with a high degree of certainty, and endometrial sampling or direct visualization with hysteroscopy is recommended in women with suspected endometrial pathology [10,50,51]. In the setting of focal endometrial pathology, an accurate description of the location of the abnormality may direct hysteroscopic resection. US sonohysterography is helpful to distinguish between focal or diffuse pathology in the setting of a postmenopausal woman with AUB and a thickened endometrium on TVUS [58]. However, US sonohysterography cannot distinguish between benign endometrial pathology and endometrial cancer with a high degree of certainty, and endometrial sampling or direct visualization with hysteroscopy is recommended in women with suspected endometrial pathology [10].