探讨三维超声诊断弓形子宫与纵隔子宫的准确性，构建弓形子宫与纵隔子宫鉴别诊断的定量指标。

对2011年8月至2013年3月复旦大学附属妇产科医院临床检查拟诊为子宫畸形的96例患者行三维超声检查，在Omni view成像模式下对子宫三维容积图像进行子宫冠状面的重建、测量分析和分型诊断。与宫（腹）腔镜诊断结果对照，计算三维超声诊断弓形子宫、不全纵隔子宫和完全纵隔子宫的敏感度、特异度、阳性预测值、阴性预测值及总体符合率。构建弓形子宫与纵隔子宫鉴别诊断的定量指标。

96例患者经三维超声诊断为弓形子宫33例（34.4%，33/96），不全纵隔子宫54例（56.2%，54/96），完全纵隔子宫9例（9.4%，9/96）。三维超声诊断弓形子宫和纵隔子宫的总体符合率为86.5%（83/96）。三维超声诊断弓形子宫的敏感度、特异度、阳性预测值、阴性预测值分别为100%、82.9%、60.6%、100%；诊断不全纵隔子宫的敏感度、特异度、阳性预测值、阴性预测值分别为80.6%、100%、100%、69.1%；诊断完全纵隔子宫的敏感度、特异度、阳性预测值及阴性预测值均为100%。纵隔子宫的子宫内膜凹陷深度占子宫底部浆膜层-纵隔顶端间距的50%以上，而大部分弓形子宫的子宫内膜凹陷深度占子宫底部浆膜层—纵隔顶端间距的50%以下。

三维超声对不同分型子宫畸形的诊断准确率不同。应用三维超声定量指标辅助诊断，有助于提高三维超声诊断弓形子宫与纵隔子宫的准确率。

To discuss the accuracy of three-dimensional (3D) sonography in diagnosing arcuate uterus and septate uterus and propose a quantitative indicator in distinguishing arcuate uterus and septate uterus.

Ninety-six patients with suspected congenital uterine malformation underwent 3D sonography to assess uterine anomalies at Obstetrics and Gynecology Hospital of Fudan University from August 2011 to March 2013. Uterine coronal section was reconstructed and measured in omni view imaging mode of 3D sonography. Then qualitative diagnosis and categorization was done. The results were compared with diagnosis of hysteroscopy, hysteroscopy combined with laparoscope to determine the sensitivity, specificity, positive predictive values, negative predictive values and total accuracy of 3D sonography in diagnosing arcuate uterus, partial and complete septate uterus respectively. The variable was created in coronal section of uterus constructed through 3D imaging mode to differentiate arcuate uterus from septate uterus.

There were 33 cases (34.4%, 33/96) of arcuate uterus, 54 cases (56.2%, 54/96) of partial septate uterus and 9 cases (9.4%, 9/96) of complete uterus in 96 cases diagnosed by 3D sonography. The accuracy of 3D sonography in diagnosing arcuate uterus and septate uterus was 86.5%. We concluded that 3D sonography had 100% sensitivity, 82.9% specificity, 60.6% positive predictive value and 100% negative predictive value in the diagnosis of arcuate uterus. The sensitivity of 3D sonography for diagnosis of partial septate uterus was 80.6%, the specificity was 100%, the positive predictive value was 100%, and the negative predictive value was 69.1%. The sensitivity, specificity, positive and negative predictive values of 3D sonography for detecting complete septate uterus were all 100%. The ratio of depth of uterine internal indentation and depth from uterine fundus to the top of internal indentation was more than 50% for septate uterus, while less than 50% for most of the arcuate uterus.

The diagnostic efficiency of 3D sonography in specific uterine malformation is different. The new quantitative indicator maybe helpful in improving the accuracy of 3D sonography in diagnosing arcuate uterus and septate uterus.