Uterine cervical volume: comparison between two- and three-dimensional ultrasound methods at 20-24 weeks of gestation

Cardozo, Renan Fonseca; Peixoto-Filho, Fernando Maia; Araujo Júnior, Edward

doi:10.1590/0100-3984.2025.0002

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Original Article • Radiol Bras 58 • 2025 • https://doi.org/10.1590/0100-3984.2025.0002 linkcopy

Uterine cervical volume: comparison between two- and three-dimensional ultrasound methods at 20-24 weeks of gestation

Volume cervical uterino: comparação entre métodos ultrassonográficos bidimensional e tridimensional entre 20 e 24 semanas de gestação

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective: The purpose of this study was to evaluate the agreement between and reproducibility of specific two-dimensional (2D) and three-dimensional (3D) ultrasound methods in assessing cervical volume in pregnant women in their second trimester.

Materials and Methods: This was a prospective cross-sectional study of 48 asymptomatic pregnant women at 20–24 weeks of gestation. All cervical volumes were determined by transvaginal ultrasound, with a 2D method employing a geometric formula {π * [(anteroposterior diameter + transverse diameter) * ¼] * length}, where π = 3.14, and a 3D method employing a virtual organ computer-aided analysis. Intraobserver and interobserver reliability was analyzed by calculating the intraclass correlation coefficient (ICC).

Results: The mean maternal age and timing of the ultrasound examination were 26 ± 6 years and 21 ± 1 weeks of gestation, respectively. The mean cervical volumes measured by the 2D and 3D ultrasound methods were 27.71 ± 9.27 cm³ and 35.21 ± 8.85 cm³, respectively. Cervical length and volume showed a positive correlation with both methods–r = 0.77 (p < 0.001) and r = 0.70 (p < 0.001), respectively. Intraobserver reliability was excellent for both methods, with ICCs of 0.92 and 0.93 for the 2D and 3D methods, respectively. Interobserver reliability was good (ICC: 0.81) for the 3D method, whereas it was poor (ICC: 0.37) for the 2D method. Reproducibility of the transverse diameter measurement was low, with an intraobserver ICC of 0.41 and an interobserver ICC of 0.48.

Conclusion: Cervical volume measurements obtained with 2D and 3D ultrasound methods seem to show satisfactory agreement and good intraobserver reliability. In our study sample, the 2D ultrasound method showed low interobserver reliability, whereas the 3D ultrasound method was more reliable, with good intraobserver and interobserver reliability.

Keywords:
Pregnancy; Cervical length measurement; Cervix uteri/embryology; Pregnancy trimester, second; Ultrasonography, prenatal/methods; Reproducibility of results

Characteristic	(N = 48)
Maternal age (years), mean ± SD	26 ± 6
Gestational age (weeks), mean ± SD	21 ± 1
Body mass index (kg/m²)
Mean ± SD	25.85 ± 6.13
< 18.5, n (%)	2 (4.2)
18.5–24.9, n (%)	23 (47.9)
25.0–29.9, n (%)	15 (31.2)
30.0–34.9, n (%)	4 (8.3)
35.0–39.9, n (%)	3 (6.2)
≥ 40.0, n (%)	1 (2.1)
Years of schooling
Mean ± SD	10 ± 3
0–4, n (%)	3 (6.2)
5–9, n (%)	17 (35.4)
10–12, n (%)	19 (39.6)
≥ 13, n (%)	9 (18.8)
Ethnicity n (%)
White	12 (25.0)
Mixed	24 (50.0)
Black	7 (14.6)
Other	5 (10.4)

Measure	Mean ± SD	Variation
Cervical dimensions (cm)
Length	3.5 ± 0.64	2.27 – 5.24
Anteroposterior diameter	3.12 ± 0.39	2.24 – 4.24
Transverse diameter	3.15 ± 0.36	2.06 – 4.40
Cervical volume (cm³)
3D ultrasound method
Observer 1
1st measurement	32.95 ± 7.94	13.84 – 48.95
2nd measurement	34.22 ± 8.40	12.52 – 50.70
Observer 2
Single measurement	38.44 ± 9.38	16.59 – 58.91
2D ultrasound method
Observer 1
1st measurement	24.80 ± 6.44	12.30 – 36.95
2nd measurement	23.02 ± 5.64	11.23 – 33.88
Observer 2
Single measurement	35.30 ± 9.93	16.74 – 67.19

Measure	ICC	95% CI
Inter-method reliability
Observer 1	0.58	0.25 to 0.76
Observer 2	0.80	0.64 to 0.88
Interobserver reliability
3D ultrasound method	0.81	0.67 to 0.89
2D ultrasound method	0.37	−0.10 to 0.65
Intraobserver reliability
Observer 1
3D ultrasound method	0.93	0.88 to 0.96
2D ultrasound method	0.92	0.87 to 0.96

Measure	ICC	95% CI
Intraobserver reliability
Observer 1
Length	0.95	0.91 to 0.97
Anteroposterior diameter	0.94	0.89 to 0.96
Transverse diameter	0.41	−0.04 to 0.67
Interobserver reliability
Observer 1 vs. observer 2
Length	0.60	0.30 to 0.78
Anteroposterior diameter	0.57	0.25 to 0.76
Transverse diameter	0.48	0.08 to 0.70

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[TFN1] SD, standard deviation.