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Radiation exposure of the ovaries during hysterosalpingography. Is radionuclide hysterosalpingography justified?

Before the introduction of radionuclide hysterosalpingography in our clinic we measured the ovarian radiation exposure during hysterosalpingography (HSG) with fluoroscopy. Radiation dosage varied from 0.33 to 3.74 mGy and increased with both the number of spot films taken and the duration of fluoroscopic exposure. Compared with the conventional HSG, radionuclide HSG delivers an approximately 25 times higher dose of ionizing radiation to the ovaries.

Fallopian Tubes↗

Technetium-99m hysterosalpingography in infertility: an accurate alternative to contrast hysterosalpingography.

Thirteen infertile women who had undergone tubal surgery within the previous year for the correction of tubal obstruction, were studied with both conventional and radionuclide hysterosalpingography. The studies were performed on the same day, were interpreted independently, and the results were then compared. Three cases were excluded from analysis because of the technical inadequacy of one of the studies. Assuming the findings of the conventional studies to represent "truth," the sensitivity, specificity and accuracy of the radionuclide studies were 100%, 60% and 80% respectively.

Fallopian Tubes↗

The therapeutic effects of oil-soluble hysterosalpingography contrast medium following water-soluble hysterosalpingography contrast medium.

Previous studies have revealed that patients who underwent hysterosalpingography (HSG) with an iol-soluble contrast medium (OSCM) rather than a water-soluble contrast medium (WSCM) had higher subsequent fertility rates. In this randomized prospective study, the fertility rates among 109 patients following HSG were found to be 31% (19/61) in the WSOM group and 38% (18/48) in the WSOM + OSCM group. No significant difference was noted between these two groups, whether their infertility was associated with endocrine factor, male factor, endometriosis, mechanical factor or some other unexplained factor.

Adult↗

Hysterosalpingography with color Doppler ultrasonography.

To assess the accuracy of the diagnosis of tubal occlusion with the use of color Doppler flow ultrasonography and hysterosalpingography, 129 infertile women were studied. All 129 women had the procedure performed with an ATL Ultramark 9 (Advanced Technology Laboratories, Bothel, Wash.) color Doppler ultrasonography machine. Eighty-five of the 129 women also had an additional study including x-ray hysterosalpingography and/or chromopertubation. Of these 85 women, 58 had pelviscopic examination with chromopertubation. The frequency of diagnosis of tubal occlusion was compared among the three methods. When results of ultrasonography-hysterosalpingography were compared with those of x-ray hysterosalpingography and/or chromopertubation, 69 of 85 (81%) studies showed agreement, and 50 of 58 (86%) ultrasonography-hysterosalpingography findings agreed with observations at chromopertubation. The frequency of comparable findings between x-ray hysterosalpingography and chromopertubation is 75%. These data suggest that ultrasonography-hysterosalpingography is at least as accurate as x-ray hysterosalpingography in diagnosing tubal occlusion. In addition, ultrasonography-hysterosalpingography is safer and more cost-effective than x-ray hysterosalpingography and chromopertubation.

Evaluation Studies as Topic↗

[Diagnostic value of hysterosalpingography and laparoscopy in infertile women].

UNLABELLED: Tubal pathology with tubal blockage due to the pelvic inflammatory diseases is one of the most frequent causes of infertility in a woman [1]. The two most important diagnostic procedures which are used for evaluation of tubal patency are hysterosalpingography and laparoscopic hydrotubation [4]. SUBJECT: The aim of the study was the comparison of hysterosalpingographic and laparoscopic findings and determination of accuracy of these two procedures in the diagnosis of tubal patency. MATERIAL AND METHODS: We studied and compared the results of hysterosalpingography and laparoscopy in 102 infertile women who were operated on at the Narodni Front Hospital of Gynaecology and Obstetrics in Belgrade during 1993 and 1994. Of 102 operated women 47 women were with primary infertility and 55 with secondary infertility. The patients were from 20 to 41 years of age, the average 28 +/- 2.4 years. RESULTS: Of one hundred and two operated women tubal blockage was found in 94 (92.1%) patients. Unilateral hydrosalpinx was found by hysterosalpingography in 16 (15.7%) subjects and bilateral hydrosalpinx in 30 (29.4%) women. Unilateral hydrosalpinx was found by laparoscopy in 17 (16.1%) patients and bilateral hydrosalpinx in 32 (31.4%) subjects. The concordant findings by hysterosalpingography and laparoscopy in the diagnostics of unilateral hydrosalpinx were found in 76.5% of cases, and in bilateral hydrosalpinx in 70.4%. This difference was not statistically significant. Unilateral tubal blockage was identified by laparoscopy in 26 (25.5%) patients and bilateral in 27 (26.5%) subjects. The concordant findings by hysterosalpingography and laparoscopy in unilateral tubal blockage were found in 61.5% of cases, and in bilateral tubal blockage in 70.4% of women. The total concordant findings by hysterosalpingography and laparoscopy in tubal blockage were found in 65.7 of cases, and concordant findings after hysterosalpingography and surgery were noted in 61.7% cases. The findings by laparoscopy and surgery were in harmony in 86.3% patients. Ovarian abnormalities were found by laparoscopy and surgery in 22 (21.6%) women. Pelvic adhesions were found by laparoscopy in 42 women of 49 patients in whom pelvic adhesions were found during the operation. Uterine congenital anomalies were found by laparoscopy in 3 (2.9%), women and by hysterosalpingography in 6 (5.9%) patients. DISCUSSION: Of 102 operated women tubal blockage was found in 94 (92.2%) women. Unilateral tubal blockage was found in 38 (40.4%) patients, and bilateral tubal blockage in 56 (59.6%) subjects. Hysterosalpingographic and laparoscopic hydrotubation findings in the diagnosis of tubal patency were concordant in 65% of cases, hysterosalpingographic and operative findings in 61.7% of patients, and laparoscopic and operative findings in 86.3% of subjects. Although concordant findings of 65.7% were noted in this study, which were similar to findings of other authors, the percentage of 62.5% [4], and 76% was observed [5]. During the operation pelvic adhesions were found in 49 patients, and laparoscopic in 42 women only. Ovarian abnormalities were found by laparoscopy in 22 (21.6%) patients, while uterine fibroid was found in 10 (9.8%) subjects. Uterine congenital anomalies were found by hysterosalpingography in 6 (5.9%) cases and by laparoscopy only in 3 (2.9%) patients. The advantage of visual hysterosalpingography seems to be in identification of some congenital uterine anomalies. However, the advantage of laparoscopy is identified by the possibility of visualisation of some other pelvic abnormalities which may be the cause of infertility. CONCLUSION: There are some hysterosalpingographic and laparoscopic advantages and disadvantages in the diagnosis of infertility in women. Only by using both procedures accurate results can be achieved in the tubes, the uterus and the ovary, that can be a cause of infertility in women.

Adult↗

Modified hysterosalpingography during infertility work-up: use of contrast medium and saline to investigate mechanical factors.

OBJECTIVE: To evaluate the effectiveness of modified hysterosalpingography using <3 mL amount of contrast medium followed by injection of saline to minimize the adverse effects associated with the procedure. DESIGN: For modified hysterosalpingography, 1-2 mL of water-soluble contrast medium were injected to visualize the uterine cavity, followed by injection of 10 mL of saline to check tubal patency and spillage. A control group of patients underwent hysterosalpingography with undiluted contrast medium. SETTING: Teaching hospital. PATIENT(S): Seventy-eight infertile women [study (n = 40)/control (n = 38) groups]. INTERVENTION(S): Modified and standard hysterosalpingography. MAIN OUTCOME MEASURE(S): Assessment of uterine cavity, tubal patency, and sensation of pain during modified hysterosalpingography was compared with that during standard hysterosalpingography. RESULT(S): Uterine cavity and tubal patency were properly visualized during modified hysterosalpingography. Saline pushed the contrast medium successfully from the uterine cavity through the open fallopian tubes and into the pelvic cavity. The study group reported significantly less pain than did the control group. Between-group differences were statistically significant when pain perception (no pain vs. minimal pain vs. severe pain; no pain vs. any kind of pain) was analyzed by type of adnexal pathology (bilateral passage or unilateral passage). CONCLUSION(S): Modified hysterosalpingography was sufficient to diagnose tubal and pelvic mechanical factors. The procedure was associated with a significant reduction in self-reported pain and no medical complications.

Adult↗

[A comparative study between hysterosalpingography and laparoscopy in evaluating female infertility].

The diagnostic accuracy of hysterosalpingography and laparoscopy was compared. One hundred fourty three infertile women were prospectively investigated in two years duration. Laparoscopic chromopertubation using methylen blue dye performed on days 8-16. Hysterosalpingography performed on days 7-10 with water soluble contrast medium. There was agreement between the results of both methods in 66.4 per cent /95/ of the patients. In 15 of the 63 patients with a normal hysterosalpingography, however, peritubal or tubal disease was observed at the time of laparoscopy/false-negative results, 10.4%/Eighty patients with tubal obstructions were detected by hysterosalpingography, but 33 obstructions were not confirmed by laparoscopy/false-positive results, 23%/. The greatest discrepancy between the hysterosalpingography and laparoscopy was found in peritubal adhesions--58.7%. Laparoscopic evaluation demonstrated also endometriosis in 41 cases, poly cystic ovaries in 12, ovarian cyst in 9, and uterine fibroids in 15. Intrauterine abnormalities were diagnosed by hysterosalpingography in only 2.9% per cent of the patients. No significant laparoscopic complications were noted. The results suggest that hysterosalpingography is useful as a primary screening procedure, but laparoscopy provides a more accurate assessment of tubal patency and peritoneal factors in the investigation of infertility.

Adult↗

Hysterosalpingography in the 1990s.

All physicians involved in the evaluation and treatment of infertility rely heavily on the information provided by hysterosalpingography. For many years this study has provided images of the lumina of the fallopian tubes that are not available by other diagnostic means, and it also gives the most accurate outline of the uterine cavity. Hysterosalpingography will therefore continue to be a valuable study in the upcoming decade, and it is important now to take account of the many advances in technology that impinge on the execution and interpretation of this study. In this article we first update the continuing debate about elements of the study itself, involving techniques and the choice of contrast material. We also consider surgical advances, such as the widespread use of microsurgical reconstruction of the fallopian tube, that increase the demand for hysterosalpingography. Since radiologists are asked to evaluate the results of surgery, it is essential for them to be familiar with the postoperative appearances of the fallopian tube. Finally, we consider what must be by far the most important development of the 1990s, the continuing integration of hysterosalpingography with new interventional and imaging techniques. Fallopian tube catheterization expands the examination of the fallopian tube and offers new therapeutic applications. Transvaginal sonography and MR imaging have allowed noninvasive exploration of the female pelvis. Correlation of hysterosalpingography and MR imaging is particularly useful in the diagnosis of uterine myomas and congenital uterine duplication anomalies when surgery to preserve or enhance the reproductive capacity of the uterus is indicated. Sonography and MR imaging should be correlated with hysterosalpingography to provide a more efficient diagnostic and therapeutic approach to the common mechanical causes of infertility.

Catheterization↗

Hysterosalpingography before and after myomectomy: clinical value and imaging findings.

OBJECTIVE: Myomectomy is being performed increasingly for the treatment of menorrhagia and infertility. The purpose of this study was to describe the findings at hysterosalpingography before and after myomectomy and to correlate the findings with the operative technique and observations at surgery. This study also examined the value of hysterosalpingography in planning surgery, as well as in detecting postoperative complications and residual fibroids. MATERIALS AND METHODS: The study group comprised 32 patients who were consecutively referred for hysterosalpingography after myomectomy. The indications for myomectomy were infertility in all cases, associated with menorrhagia in 20, pelvic pain in 15, and urinary frequency in eight. Eighteen of the 32 patients also had hysterosalpingography before surgery. The hysterosalpingographic findings were reviewed without knowledge of the clinical findings and then correlated with surgical and pathologic findings. RESULTS: Preoperative hysterosalpingograms showed enlargement and/or distortion of the uterine cavity in 13 of 14 patients who had submucous fibroids or mural fibroids with a submucous component (mural/submucous fibroid). Cornual asymmetry was seen in seven of 18 patients, the result of an adjacent fibroid deforming one bilaterally in another two. In all four patients, tubal patency was shown after myomectomy. Intracavitary filling defects consistent with submucous or mural/submucous fibroids were found in 12 of 18 patients. After myomectomy, these defects resolved in eight cases; in the remaining four, persistent filling defects suggested residual submucous enlargement of the uterine cavity in only two of 32 patients; in both, residual mural and/or submucous fibroids were shown on sonography after surgery. Major distortion of the cavity after surgery was found in four patients; it was caused by filling defects consistent with residual submucous fibroids in two and by major synechiae in two. Diverticula at the site of resection of submucous fibroids were found in six patients. Major synechiae were found in two patients, resulting in unilateral or bilateral tubal occlusion. CONCLUSION: Hysterosalpingography before myomectomy can assist the surgeon in planning the surgical approach by showing the presence, size, and location of submucous fibroids and concomitant tubal disease. Hysterosalpingography after myomectomy shows residual fibroids and complications of surgery, such as synechiae and diverticula, that may affect further treatment.

Adult↗

Three-dimensional dynamic MR hysterosalpingography: a preliminary report.

The aim of this study was to evaluate the feasibility of three-dimensional dynamic MR hysterosalpingography (3D MR HSG) for visualization of the cavum uteri and demonstration of bilateral fallopian tube patency as an alternative to conventional hysterosalpingography. Five infertile female patients underwent 3D dynamic MR HSG prior to conventional hysterosalpingography. The MR protocol consisted of axial T1-weighted spin-echo (SE), axial/coronal T2-weighted fast SE (FSE), and 3D MR angiography sequences before, during, and after injection of a diluted gadolinium solution into the cavum uteri via a balloon catheter. Positioning of the catheter was feasible in all patients. In one patient the catheter slipped out during MRI and in one patient the catheter was placed far in the cavum uteri. In three patients catheter position was optimal at the level of the cervical canal. Evaluation of pelvic anatomy, myometrium, and ovaries was possible in all patients on the basis of T1-weighted SE and T2-weighted FSE. Three-dimensional visualization of the dilated cavum uteri was possible in four patients. In these four patients 3D MR HSG also proved bilateral fallopian tube patency which was confirmed in each patient by conventional hysterosalpingography. Three-dimensional MR HSG is feasible and further research should be done to determine if this technique can evolve into an alternative technique to conventional hysterosalpingography with the advantages of no radiation and additional visualization of the uterus wall and ovaries.

Adult↗

The diagnostic value of hysterosalpingography and hysteroscopy in infertility investigation.

Four hundred infertile patients had hysterosalpingography and hysteroscopy as part of their infertility workup. A comparison between the findings of these two procedures was carried out to study their diagnostic value in female infertility investigation. It was found that hysterosalpingography was as accurate as hysteroscopy in the diagnosis of normal or abnormal uterine cavities while the nature of the intrauterine filling defects was accurately revealed by hysteroscopy only. It is concluded that hysterosalpingography is an important screening procedure for the diagnosis of normal or abnormal uterine cavities and that hysteroscopy should be reserved only for the confirmation and treatment of intrauterine anomalies discovered by hysterosalpingography. Therefore we look at the two procedures, hysterosalpingography and hysteroscopy, as complementary techniques.

Adolescent↗

Comparison of cervical vacuum cup cannula with metal cannula for hysterosalpingography.

OBJECTIVE: The aim of this study was to compare the use of a cervical vacuum cap cannula with the traditional metal cannula. DESIGN: A prospective, randomised, single-blinded comparative study. SAMPLE: Fifty consecutive infertile women undergoing hysterosalpingography for evaluation of infertility METHODS: Hysterosalpingography was performed either with the traditional metal cannula (n = 25) or a cervical vacuum cap cannula (n = 25). MAIN OUTCOME MEASURES: Length of procedure, fluoroscopic time, amount of contrast medium, pain to the patient while applying the cannula and injecting the contrast medium, level of difficulty to the performer, the need to reapply the cannula, complications, and results of the hysterosalpingography. RESULTS: Using the cervical vacuum cap cannula, compared with the metal cannula, the duration of the procedure was significantly shorter (5.3 vs 9.3 minutes; P < 0.001), less fluoroscopic time was needed (0.9 vs 1.8 minutes; P < 0.001), a smaller amount of contrast medium was used (4.6 vs 15.7 mL; P < 0.001), the procedure caused less pain to the patient (3.2 vs 6.8, respectively; on a scale of 1-10; P < 0.001), and was easier for the physician to perform (1.4 vs 3.4; on a scale of 1-10; P < 0.001). No significant differences were encountered between the two groups in the need to reapply the cannula, in the rate of complications or in the results of the hysterosalpingography. CONCLUSIONS: The cervical cap cannula appears to be superior to the traditional metal cannula for performing hysterosalpingography.

Adult↗