الفهرس 
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Abstract
Background: Abnormal uterine bleeding is a common gynecologic complaint and it may involve females at any age group. Thirty three percent of women referred to gynecologic clinics have abnormal bleeding and this figure rises to 69% in pre-menopausal and postmenopausal women. Abnormal uterine bleeding is caused by both functional and organic causes such as endometrial polyp, hyperplasia, cancer and submucosal myoma that require medical and /or surgical treatment.
Objectives: To compare diagnostic potential of magnetic resonance imaging, three dimensional hysterosonography and diagnostic hysteroscopy in evaluation of the uterine cavity in women with premenopausal and postmenpausal bleeding scheduled for hysterectomy.
Patients and methods: This study was conducted in the Department of Obstetrics and Gynecology, Cytogenetic & endoscopy unite, and Radiology Department Zagazig university hospitals during the period between April 2010 and April 2011and comprised 30 women with pre-menopausal bleeding and 30 women with postmenopausal bleeding scheduled for hysterectomy. The aim of this study was to compare diagnostic potential of magnetic resonance imaging, three dimensional hysterosonography and diagnostic hysteroscopy in evaluation of the uterine cavity in women with premenopausal and postmenpausal bleeding. All patients included in the study were above the age of forty and before the onset of menopause (pre-menopausal group) or after at least 1 year amenorrhea (postmenopausal group). Women with sever vaginal bleeding, malignancy, other pelvic pathology (adnexal mass), pregnancy complication (in the pre-menopausal group) and under hormonal therapy were excluded from the study.
Results: In the premenopausal group; 3D hysterososonography had the highest sensitivity (85.71%) & hysteroscopy had the highest specificity (88.89%) for evaluation of uterine cavity. Regarding degree of agreement with the histopathology; Hysteroscopy had the highest degree of agreement (0.73). Combination of more than one test did not add advantage in evaluation of uterine cavity as combination of 3D-hysterosonography (the highest sensitivity) + Hysteroscopy (the highest specificity) produced lower sensitivity than 3D hysterosonography and lower specificity than hysteroscopy (80 & 85.71 % respectively) & all combinations produced lower degree of agreement with the histopatology. In postmenopausal group; MRI, 3D hysterososonography, hysteroscopy have high sensitivity (88.24%), but both hysteroscopy & 3D hysterosonography had higher specificity (84.61 %) in evaluation of uterine cavity.
Conclusion: Hysteroscopy can be considered the best method for evaluation of uterine cavity in women with premenopausal & post menopausal bleeding (85% accuracy & 0.73 agreement with histopathology). It is slightly superior but more invasive than 3D hysterosonography (83.33% accuracy & 0.69 agreement with histopathology). Also,