MR hysterosalpingography with an angiographic time-resolved 3D pulse sequence: assessment of tubal patency

OBJECTIVE: The purpose of our study was to determine if tubal patency can be assessed by MR hysterosalpingography (HSG) using a clinically available MR angiographic sequence (3D time-resolved imaging of contrast kinetics [TRICKS]). This capability would enhance the value of MRI in women with infertility. CONCLUSION: MR HSG effectively shows tubal patency and can be considered when both conventional HSG and standard MRI are necessary for the evaluation of women with infertility, such as in women with suspected uterine anomalies or extrauterine disease.     

A hybrid radiography/MRI system for combining hysterosalpingography and MRI in infertility patients: initial experience

OBJECTIVE: We evaluated the feasibility of a prototype hybrid radiography/MRI system in evaluating infertility patients. Pelvic MRI was followed by hysterosalpingography (HSG) without moving the patient. This system allowed evaluation of tubal patency and cross-sectional imaging with one examination. CONCLUSION: Our hybrid radiography/MRI system provided good-quality HSG and MR images. We were able to assess tubal anatomy and patency and uterine anatomy and to detect pelvic abnormalities, including fibroids and adenomyosis. Furthermore, MR images and radiographs were superimposed to clarify HSG findings.     

子宫输卵管造影与宫腹腔镜联合探查诊断输卵管通畅性的对比研究

目的探讨高压恒速子宫输卵管造影(hysterosalpingography,HSG)与宫腹腔镜联合检查在诊断输卵管通畅性中的意义。资料与方法回顾性分析36例不孕症患者的HSG资料。均先后行HSG和宫腹腔镜联合探查,间隔时间<1个月。依据诊断标准评价输卵管的通畅性及宫腔、盆腔异常表现。结果 36例共计71支输卵管,HSG通畅30支,阻塞41支,腹腔镜通畅35支,阻塞36支,两者结果一致56支。HSG敏感性为86.1%,特异性为71.4%,阳性似然比3.01,阴性似然比0.19,准确性为78.9%;两组诊断结果比较差异无统计学意义(χ2=0.71,P=0.302),吻合强度差异有统计学意义(k=0.577,P=0.000)。结论 HSG可有效、廉价、快速检查输卵管通畅性,可作为输卵管性不孕检查的首选筛查方法 。     

输卵管妊娠后慢性输卵管炎的造影分析

目的 研究慢性输卵管炎的造影表现,提高子宫输卵管造影术(HSG)对输卵管性不孕的诊断能力,并对输卵管妊娠患者再次备孕提供指导.方法 回顾性分析2018年1月至2019年8月在我院就诊的既往有输卵管妊娠史患者的资料,共计58例,115条输卵管,其中输卵管妊娠患病64条.在月经干净以后3～7 d内进行HSG检查,观察输卵管...     

Diagnostic value of hysterosalpingography in the detection of intrauterine abnormalities: a comparison with hysteroscopy

OBJECTIVE: The purpose of this study was to evaluate the diagnostic accuracy of hysterosalpingography (HSG) in comparison with hysteroscopy in the detection of intrauterine abnormality in infertile patients. MATERIALS AND METHODS: Seventy-eight patients being investigated for infertility and undergoing HSG and hysteroscopy were studied retrospectively. Radiologic findings on HSG, including single or multiple filling defects and uterine wall irregularities, were evaluated and compared with hysteroscopic findings, which were considered the reference standard. RESULTS: HSG showed a sensitivity of 81.2% compared with that of hysteroscopy and a specificity of 80.4%, with a positive predictive value of 63.4% and a negative predictive value of 83.7%. HSG also had a false-negative rate of 90% and a false-positive rate of 21.8%. Overall agreement between the two procedures was 73%. CONCLUSION: HSG is still a useful screening test for the evaluation of the uterine cavity in the study of primary or secondary infertility. In addition, HSG provides information concerning the assessment of tubal morphology and patency. We believe that these two procedures are complementary in the evaluation of the uterine cavity.     

Hysterosalpingography in the assessment of proximal tubal pathology: a review of congenital and acquired abnormalities

Tubal and peritoneal disease are the main causes of infertility. Tubal pathology can be either congenital malformation or acquired, proximal or distal, unilateral or bilateral and transient or permanent. Several imaging methods such as laparoscopy, fluoroscopy, saline infusion sonography, and hysterosalpingography (HSG) have been used in the assessment of tubal and peritoneal pathology. Although laparoscopy is the modality of choice for investigating tubal patency and pelvic structure in many infertility centers, HSG is usually the initial diagnostic method for infertility workup because of its ease of performance, accuracy, and minimal risk of complications. This method provides useful information about size, contour, and anatomy of the inner surface of the fallopian tubes and is the gold standard for evaluation of tubal lumen. Tubal and peritubal pathology show various imaging manifestations on HSG. This review illustrates the radiographic features of congenital and acquired structural abnormalities of the proximal tubal pathology and along with etiology of proximal obstruction or occlusion will be described.     

A radiological approach to infertility--hysterosalpingography.

The hysterosalpingograms of 98 patients with infertility were reviewed with reference to technical problems, radiological features of each pathology and accuracy of reporting. Findings were confirmed by review of the reports of laparotomy or laparoscopy on all patients. Of the total number of fallopian tubes investigated (196), 70 hydrosalpinges were correctly diagnosed from a total of 77. Agreement between HSG and operation was achieved in 123 of 127 fallopian tubes with peritubal adhesions, in all six of those with cornual spasm and in eight with cornual occlusion. In 16 of 20 fallopian tubes with partial distal occlusion, reporting was correct. With the potential accuracy of HSG diagnosis, we contend that it should be a preliminary procedure in every case, and in many may be the only investigation of tubal patency required prior to surgery or conservative management.     

Fallopian tube patency demonstrated at ultrasonography

Fallopian tube patency was assessed in 24 infertile patients by hysterosalpingography (HSG) and ultrasonographic examination of the pouch of Douglas following transcervical injection of a sterile isotonic solution of NaCl. The presence of fluid in the pouch, after the injection, was taken to indicate tubal patency. The results of the HSG and the ultrasonographic diagnosis as to the presence of at least unilateral tubal patency were concordant in 21 patients. Pitfalls consisted of fluid accumulation in periadnexal adhesions, edema in the bowel wall, and spill of the injected saline into a large hydrosalpinx. Ultrasonography is advocated as the initial examination in assessing infertility in young women. If tubal patency is demonstrated, the patient should be recommended a six month trial period, to become pregnant, before invasive procedures are initiated.     

子宫输卵管造影与子宫腹腔镜检查诊断女性不孕症的对比分析

目的探讨输卵管通液治疗仪子宫输卵管造影(HSG)对女性不孕症的诊断价值。方法 116例经临床与病理证实的女性不孕症患者均经HSG和子宫-腹腔镜(H-LSC)检查。对获自上述两种技术的资料,进行了对比性分析。结果在116例中,H-LSC发现导致不孕的各种病变111例(95.7%),其中检出率较高的几种病变是盆腔炎性粘连(n=87),输卵管炎性阻塞(n=85),子宫肌瘤(n=14),多数患者有两种或以上病变并存;HSG发现导致不孕的各种病变107例(92.2%),HSG对输卵管炎性阻塞的检出(n=106)高于H-LSC,而对盆腔炎性粘连(n=51)和子宫肌瘤(n=2)的检出低于H-LSC。本组HSG诊断女性不孕症的敏感性、特异性、准确性、阳性预测值以及阴性预测值分别为96.4%,80%,56.9%,93.9%以及69.2%。结论 H-LSC和HSG在诊断女性不孕症中各有所长,总体来说,H-LSC优于HSG,但二者不能相互取代而是应优势互补。HSG联合H-LSC检查是目前诊断女性不孕症的最佳方案。     

99TcmO4-输卵管显像对不孕症患者腹腔镜手术的价值

目的应用99TcmO₄-输卵管显像研究不孕症患者X线子宫输卵管造影（HSG）显示机械性通畅输卵管的功能受损程度,进而研究99TcmO₄-输卵管显像对腹腔镜手术的价值。 方法对HSG显示至少一侧输卵管通畅或通而不畅的不孕症女性患者166例（通畅输卵管91条,通而不畅输卵管222条,单侧不通输卵管19条）行99TcmO₄-输卵管显像。并对HSG显示通畅的91条输卵管进行99TcmO₄-输卵管显像及腹腔镜对比分析。采用SPSS 17.0软件对HSG检查通畅输卵管99TcmO₄-显像的输卵管功能损伤程度与腹腔镜检查的输卵管通畅性进行比较并行χ2检验。 结果对HSG显示输卵管机械性通畅（包括通畅及通而不畅）的不孕症患者,99TcmO₄-输卵管显像结果显示输卵管功能受损的阳性率为78.3%。对不孕症患者HSG检查显示通畅的输卵管,行99TcmO₄-显像及腹腔镜结果比较,其差异有统计学意义（χ2=27.56,P < 0.05）。其中,若腹腔镜显示通畅,则放射性核素99TcmO₄-输卵管显像显示输卵管功能以正常及轻度受损为主;若腹腔镜显示通而不畅,则放射性核素99TcmO₄-输卵管显像显示输卵管功能以中、重度受损及无功能为主。 结论放射性核素99TcmO₄-输卵管显像对输卵管功能受损程度及通畅性的判断具有重要价值,对临床腹腔镜手术选择具有重要指导价值,尤其对HSG显示输卵管通畅的不孕症患者能否进行腹腔镜手术价值更大。     

Can hysterosalpingocontrast-sonography replace hysterosalpingography in the assessment of tubal subfertility?

INTRODUCTION: Hysterosalpingo-contrastsonography (HyCoSy) is a new method for assessing tubal patency using transvaginal ultrasound. It is thought to have several advantages over conventional hysterosalpingography (HSG). We prospectively evaluated the performance of HyCoSy and HSG in the diagnosis of tubal pathology. METHODS AND PATIENTS: One-hundred consecutive subfertile women underwent both HyCoSy and HSG in randomised order. Results of both tests were related to findings at laparoscopy with dye, which was used as the reference test. Each woman was asked to score the pain exsperienced at both procedures on a visual analogue scale. RESULTS: When laparoscopy with dye was used as reference test, the likelihood ratios of HyCoSy were slightly inferior to those obtained for HSG. Since the performance of HyCoSy was dependent on experience, the results were recalculated omitting the 50 initial procedures from the analysis. In that calculation, results of HyCoSy and HSG were comparable. There were no differences in pain experienced during the procedure, as there appeared also to be no differences in patient preferences. CONCLUSION: There appear to be no strong arguments either to replace HSG by HyCoSy, or to reject the use of HyCoSy. Both procedures can be used in the evaluation of tubal pathology.     

Dynamic ultrasonic hysteroscopy

An attempt was made to establish Dynamic Echohysteroscopy (DEHS) diagnostic criteria for the study of female genital apparatus, as recently proposed. DEHS consists of a pelvic ultrasonography during and following an injection of physiological solution in the uterine cavity. Since this technique does not use X-rays, it has been proven useful to study female infertility. The authors have studied the normal and pathological aspects of 33 patients who underwent both DEHS and hysterosalpingography (HSG) (comparison diagnostic test). The results lead to the following conclusions: 1) DEHS can be considered a useful alternative to HSG, in the evaluation of uterine pathology; 2) in the evaluation of tubal pathology, DEHS has fewer diagnostic possibilities than HSG. Nevertheless, DEHS indirectly allows the patency of at least one tube.     

Therapeutic value of hysterosalpingography with lipiodol ultra fluid

Hysterosalpingography (HSG) with lipiodol ultra fluid was performed in 294 infertile women with a normal ovulatory temperature curve and at least two years of infertility and a partner with normal sperm. In 21 per cent, pregnancy occurred within 6 months after the examination, and about one third of the women with a normal finding or with intraperitoneal adhesions at HSG conceived. The pregnancy rate was especially high in the first two cycles after HSG. The spontaneous pregnancy rate was 8 per cent, and the difference between this and the total number of pregnancies must be attributed to a therapeutic effect of the procedure. Previous pelvic inflammatory disease was present in 40 per cent of those who did not become pregnant, while only 11 per cent of those who conceived had previous inflammation. Of the women without previous gynecologic disease 30 per cent conceived.     

Multidetector computed tomography virtual hysterosalpingography in the investigation of the uterus and fallopian tubes

OBJECTIVE: To compare the efficacy of multidetector CT virtual hysterosalpingography (MDCT-VH) with conventional X-ray hysterosalpingography (HSG) in the evaluation of patients with diagnosis of infertility. METHODS: Sixty patients with diagnosis of infertility scheduled to perform a HSG, were evaluated with 16-row (n=50) and 64-row (n=10) MDCT-VH. In 35 patients the examination was performed without a tenaculum. The HSGs were carried out using standard technique. The HSG and MDCT-VH findings were compared. The duration for both examinations and patient discomfort were documented. The sensitivity and specificity of MDCT-VH for the detection of uterine pathology and tubal obstruction were calculated using the exact binomial method. Agreement between the two methods was assessed by the Cohen's kappa method (k). RESULTS: The mean duration for MDCT-VH (16 and 64-rows) was 5+/-3min, whereas for HSG was 28+/-3. The MDCT-VH without a tenaculum was the procedure with less patient discomfort. Sensitivity, specificity and inter-method agreement for the detection of uterine pathology were 100%, 92% and k=0.92 for 16-row MDCT-VH and 100%, 100% and k=1 for 64-row MDCT-VH, respectively. Sensitivity and specificity for detection of tubal obstruction were 80% and 80% for 16-row MDCT-VH and 100% and 100% for 64-row MDCT-VH, respectively; inter-method agreement for the visualization of the tubes was k=0.54 for 16-row MDCT-VH and k=1 for 64-row MDCT-VH. CONCLUSION: This study demonstrated the feasibility of evaluating the female reproductive system by MDCT-VH. 64-Row MDCT-VH could be an alternative diagnostic technique in the infertility workup algorithm. A larger study is in progress to validate these encouraging results.     

Tubal catheterization with selective salpingography in the diagnosis and therapy of fallopian tube obstruction]

Fallopian tube catheterization with selective ostial [correction of osteal] salpingography is a new technique for the diagnosis of tubal factors of infertility and also for the treatment of proximal tubal occlusion (PTO). In this study, 246 women were considered, 20-42 years old, with primary or secondary infertility, who presented a unilateral or bilateral PTO at hysterosalpingography (HSG). Catheterization and selective salpingography have been successful in 93.9% of the cases. Failures (5.6%) have been ascribed to obstructive organic diseases, where it was impossible to overcome the stenosis with the catheter or the guide-wire. Twenty-six spontaneous pregnancies were obtained (15 full-term deliveries) and 17 patients became pregnant after GIFT (13 full-term deliveries). At follow-up, after 12 months 4 of 10 patients had normal tubes, while 6 patients presented a new unilateral or bilateral PTO. No major complications occurred; nevertheless, ectopic pregnancy is a possible event, because of the mechanically re-established patency in a nonfunctioning tube.     

数字减影技术在不孕症诊断和治疗中的应用

目的：探索数字减影技术在不孕症诊断和治疗中的应用价值。方法：在X线数字减影设备下用复方泛影葡胺对164例不孕症患者行子宫输卵管造影，并用导丝对其中35例输卵管阻塞的患者进行输卵管再通治疗。结果：90.9％(149／164)患者造影发现异常，包括子宫发育异常24例，输卵管阻塞114例，输卵管结核3例，盆腔粘连29例。输卵管再通成功率82．9％，再通后受孕率为34．3％。结论:数字减影成像技术大大提高了子宫输卵管造影对病变的检出率和诊断的准确率；水溶性对比剂比碘油更加准确、安全；输卵管再通术可作为输卵管阻塞患者初步治疗的首选方法。     

HyCoSy--as good as claimed?

Hysterosalpingo contrast sonography (HyCoSy) has been compared favourably in the literature with hysterosalpingography (HSG). It does not require ionizing radiation and demonstrates the uterus and ovaries. HyCoSy is reported as being a safe, well tolerated, quick and easy investigation of Fallopian tube patency. Over a 1-year period HyCoSy was performed by two operators on 118 consecutive women who were thought likely to have patent Fallopian tubes. The examinations were graded using a local scale to assess discomfort and were correlated with tubal patency. HSG was performed on 116 patients by the same operators and discomfort recorded. 15 patients underwent both examinations. The degree of pain or reaction was graded 0 (no pain) to 4 (maximum) according to a locally devised scale. Costs of the two examinations were estimated. 89 patients examined by HyCoSy were graded 0-2. However, 23 had severe protracted pain and/or vasovagal reactions with bradycardia and hypotension. Of these, seven required resuscitation owing to prolonged symptoms, requiring treatment with atropine. 19 of the 23 had bilaterally patent Fallopian tubes. Where subsequent HSG was performed, tubal occlusion was confirmed in 8 of 15 women. Other pathologies were noted in 29 of the HyCoSy patients and there were six technical failures. During the same period no severe adverse reactions occurred in 116 patients having HSG performed by the same operators. Three of the HSG examinations were technically unsuccessful. Discomfort following HyCoSy was much greater than that reported previously. Possible mechanisms are discussed but it does not appear to be related to tubal occlusion. Diagnostic accuracy, costs and discomfort compare unfavourably with HSG.     

Terbutaline in diagnosis of interstitial fallopian tube obstruction

Effectiveness of terbutaline, a potent uterine muscle relaxant, for differentiation of temporary and anatomic interstitial fallopian tube obstruction (IFTO) at hysterosalpingography (HSG) was explored. In 43 IFTO evaluated, HSG after terbutaline showed patency in only one of 16 tubes in which IFTO was caused by spasm or other temporary cause. We conclude that terbutaline is not helpful in differentiating temporary from anatomic tubal obstruction during HSG.     

数字透视在不孕症诊治中的应用

目的探讨数字透视在不孕症诊断和治疗中的应用价值。方法在数字透视下对499例不孕症患者作子宫输卵管造影,并用导丝对其中351例输卵管阻塞患者作输卵管再通术治疗。结果89%的患者(444/499)造影发现异常,其中,输卵管阻塞297例,输卵管结核13例,子宫粘连39例,盆腔粘连87例,子宫发育异常8例。输卵管再通成功率89%,再通后受孕率36%。结论数字透视下子宫输卵管造影提高了对疾病的检测率和诊断的准确率;减少了医患双方的X线辐射;水溶性对比剂比碘油安全、准确;输卵管再通术可作为输卵管阻塞性疾病治疗的首选方法。     

经阴道四维子宫输卵管超声造影在不孕症诊断中的应用价值

目的:探讨经阴道子宫输卵管四维超声造影(TVS 4D-HyCoSy)在不孕症诊断中的应用价值。方法:本研究对2012年1月至2013年6月前来就诊的女性不孕症患者采用新型微泡对比剂行TVS 4D-HyCoSy经阴道四维造影技术评判输卵管的通畅性,实时动态观察对比剂在宫腔、输卵管内流动的过程及显影效果,并与X线子宫输卵管造影(X-HSG)进行对比。结果:33例不孕症患者TVS 4D-HyCoSy共检查66条输卵管。以X-HSG为标准,超声造影评价输卵管通畅的符合率为96.43%(27/28),通而不畅的符合率为100%(25/25),阻塞的符合率为89.23%(14/13),总体符合率为92.83%。2种方法判断输卵管通畅性的能力相当(P0.05,K0.75),且均未出现与对比剂相关的不良反应。结论:应用SonoVue行TVS 4DHyCoSy能安全、有效地显示子宫输卵管的形态,并准确判断其通畅性,是检查输卵管通畅性的有效方法。