Rendimiento diagnóstico de la histerosalpingografía por resonancia magnética: resultados iniciales / Diagnostic performance of magnetic resonance hysterosalpingography: initial results Abstract

Objetivo: Determinar el rendimiento diagnóstico de la histerosalpingografía por resonancia magnética (HSG-RM), utilizando la laparoscopia como método de referencia. Materiales y métodos: Se incluyeron 22 pacientes. A todas se les realizó una HSG-RM con un resonador 1.5 Tesla y luego una laparoscopia con cromotubación. Dos radiólogos examinaron las RM, determinando la permeabilidad tubaria por consenso. Se realizaron análisis descriptivos y de rendimiento diagnóstico. Resultados: La HSG-RM tuvo una tasa de éxito del 91%. La duración del estudio fue 49ą15 minutos, el volumen inyectado 26 ą 16 cm³ y la escala de dolor 30ą 19 de 100. La sensibilidad y especificidad de la HSG-RM fueron del 100% para la prueba de Cotte global y a la izquierda, y del 25% y 93,3% para la prueba de Cotte a la derecha, respectivamente. Hubo 2 complicaciones menores y ninguna importante. Discusión: Nuestros resultados iniciales demostraron una alta sensibilidad y especificidad. Si bien otros estudios analizaron la capacidad de la HSG-RM para evaluar la permeabilidad tubaria con buenos resultados, el uso de un patrón de referencia defectuoso dejaba margen para una duda razonable, impidiendo una recomendación basada en pruebas sólidas. Sin embargo, al cotejar nuestros resultados con los publicados, observamos un alto grado de concordancia en tanto el derrame positivo se diagnostica correctamente con una especificidad de 100% o con un porcentaje cercano a esta cifra. Conclusión: La HSG-MR es una alternativa factible y segura de la HSG convencional o virtual, la histerosonografía y la cromotubación.

Objective: To determine the diagnostic performance of magnetic resonance hysterosalpingography (MRHSG) using laparoscopic chromotubation as a method of reference. Materials and methods: Twenty-two patients were included. The MRHSG was performed in a 1.5 Tesla MR scanner. Afterwards, patients underwent laparoscopic chromotubation. MR images were examined by two trained radiologists, and tubal patency was determined by consensus. A descriptive analysis was carried out, as well as an analysis of the diagnostic performance. Results: MRHSG had a 91% success rate. Exam duration of the examination was 49ą15min, with an injected volume 26ą 16cc, and pain scale 30ą 19 out of 100. Sensitivity and specificity of MRHSG was 100% for global and left Cotte, and 25% and 93.3% for right Cotte, respectively. Only 2 minor and no major complications were observed. Discussion: The initial results of MRHSG have shown high sensitivity and specificity. Even though other studies have analysed the potential of MRHSG with good results, the use of a flawed reference standard left a margin for a reasonable doubt as regards its true potential, thus preventing a solid evidence based recommendation. Nevertheless, if our results are compared to those published, a high level of agreement is observed in that positive spillage is correctly diagnosed with specificities near or at 100%. Conclusion: MRHSG is a feasible and safe alternative to conventional or virtual HSG, ultrasound-hysterography and chromotubation.

Pratique de l'hysterosalpingographie a l'hopital regional de Ngaoundere

OBJECTIFS:Decrire la pratique et les resultats de l'HSG dans le Service d'Imagerie Medicale de l'Hopital regional de N'Gaoundere.MeTHODES: Il s'agit d'une etude transversale descriptive. Les donnees ont ete collectees de janvier a decembre 2012 au travers d'un questionnaire. Les 120 hysterosalpingographies effectuees durant la periode d'etude ont ete incluses. Elles representaient 72;8 des examens radiologiques specialises et 3 de toutes les radiographies. L'age moyen des patientes etait de 33 ans. Les patientes avec une gestite de 0 a 1 representaient 80;5 et celles avec une parite de 0 a 1 representaient 90. Les antecedents etaient domines par les infections genitales (75); puis les avortements spontanes (10) et les avortements provoques (8). ReSULTATS L'indication principale de l'HSG etait l'infertilite (67;50); suivie du bilan tubaire apres myomectomie (16;90); des avortements a repetition (5;83); de la pelvialgie chronique (5) et des metrorragies (5). Le produit de contraste utilise etait iode hydrosoluble; et le volume moyen administre etait de 22 ml. En moyenne; six cliches ont ete realises par patiente. Dans 65;83 aucun effet indesirable n'a ete observe. Les effets indesirables observes etaient la douleur (26;3); l'hemorragie (5;30) et le malaise vagal (2;6). 89;47 des HSG avaient une lesion. Les pathologies observees etaient les obstructions tubaires (36; 66); les malformations uterines (12;5); les hydrosalpinx (8;35); les suspicions de myome (6;70); les beances du col (5;83); les synechies uterines (5;83) et les adherences peritoneales (5;83). CONCLUSION L'HSG est l'examen radiologique specialise le plus pratique dans le bilan de l'infertilite feminine a Ngaoundere. Ses resultats sont comparables aux autres series africaines. La douleur est le principal effet indesirable

Propedêutica básica da infertilidade conjugal / Basic propedeutics of conjugal infertility

A infertilidade é um problema que afeta cerca de 10%-20% da população, com incidência variável em todo o mundo. A avaliação do casal infértil é geralmente indicada depois de um ano, tempo em que a maioria dos casais normais teria sido bem sucedida na tentativa de concepção. Algumas investigações são controversas, e, na presença de múltiplos métodos, o custo, a segurança e a conveniência deveriam ajudar a decidir o mais apropriado.

Infertility is a problem affecting approximately 10%-20% of the population with variable incidences across the world. Evaluation of a couple is generally indicated after one year, by which time most normal couples attemptiong conception would have been successful. Some of the investigations are controversial and in the presence of multiple methods of investigating one aspect, the cost, safety, convenience and evidence-base should help in deciding on the appropriate method.

Obstrução tubária em mulheres com imunofluorescência indireta positiva para clamídia / Tubal occlusion in women with indirect positive immunofluorescence for chlamydia

Objetivos: Avaliar o desempenho da imunofluorescência indireta para Chlamydia trachomatis em rastrear obstrução tubária. Métodos: Este é um estudo retrospectivo com 204 pacientes atendidas em um centro universitário e particular de infertilidade na cidade de Goiânia no período de 2006 a 2009. Para avaliar o risco de obstrução tubária as pacientes foram divididas em dois grupos: pacientes “expostas” à clamídia (imunofluorescênciaindireta ≥1:16) e “não expostas” (imunofluorescência indireta <1:16). Verificou-se, então, as pacientes que tiveram a “doença” (obstrução tubária) e “controles” (sem obstrução tubária) na histerossalpingografia. Para os cálculos foram utilizados os testes Qui-quadrado (χ2) e Exato de Fisher. O nível de p escolhido foi 0,05. Resultados: Das 72 pacientes com titulação significativa, 34 (47,2%) apresentaram a ocorrência de obstrução tubária. Em relação às 132 pacientes com titulação não significativa, somente 18 (13,7%) apresentaram obstrução tubária (p<0,001). Foi observado também um aumento progressivo entre os níveis de anticorpos e a probabilidade de obstrução tubária (p<0,001). Conclusões: Os resultados deste estudorevelaram que a sorologia para Chlamydia trachomatis é válida para rastreamento de lesão tubária, portanto, pode facilitar decisões naquelas mulheres que devem prosseguir com novas investigações.

Purpose: To evaluate the ability of indirect immunofluorescence for Chlamydia trachomatis to screening tubal occlusion. Methods: This is a retrospective study with 204 electronic records of patients attended at a university and private infertility center in the city of Goiania, in the period of 2006 to 2009. To evaluate the risk of tubal occlusion the patients were divided into two groups: patients “exposed” to chlamydia (IFI≥1:16) e “unexposed” (IFI<1:16). It was verified patients who had the “disease” (tubal occlusion) and “control” (without tubal occlusion) in the hysterosalpingography. For the calculations the Chi-square (χ2) and Fisher Exact Test were used. The p chosen level was 0,05. Results: Of the 72 patients with significant titers, 34 (47,2%) showed the occurrence of tubal occlusion. Concerning the 132 patients with no significant titers, only 18 (13,7%) had tubal occlusion(p<0,001). We also observed a progressive increase in the levels of antibodies and the likelihood of tubal occlusion (p<0,001). Conclusions: The results indicate that serology for Chlamydia trachomatis is valid for screening of tubal damage and may facilitate decisions on which women should proceed with further investigations.

Antibodies to chlamydia trachohomatis heat shock protein 60 [chlamydial HSP 60] and chlamysia trachomatis major outer membrane proten [MOMP] in women with tubal factor infertility

Most of the acute infections of Chlamydia trachomatis are asymptomatic and are thus left untreated. In some women repeated or persistent C. trachomatis infection leads to scarring of the fallopian tube tissue and subsequent infertility because of occlusion of the tubes. Screening for C trachomatis specific antibodies is mandatory in. diagnosing asymptomatic tubal factor infertility [TFI], particularly because it has been shown that C trachomatis is rarely isolated from the upper genital tract and clinical diagnosis requires invasive procedures not routinely available in general practice. C. trachomatis has immunodominant proteins such as major outer membrane protein [MOMP] and Chlamydial heat shock protein6o [chlamydial hsp60] that most of the host's immune response is directed at. The aim of the present study was to evaluate the association between, antibodies to C. trachomatis-specific IgG and chlamydial hsp60 in women with TFI. This study was done on 45 women diagnosed as having TFI by means of hysterosalpingogram [HSG] and laparoscopy, and 31 wives of male factor infertility patients with documented patent tubes by hysterosalpingogram, as a control group. Their age ranged from 19 to 35 years. Antibodies to C. trachomatis-specific IgG were more prevalent in younger women [<25 years old] than older women [>25 years old]. 77% versus 47% in TFI group, and 37% versus 27% in control group. Antibodies to C. trachomatis specific IgG were present in 29 [64%] of 45 women with tubal infertility compared with 10 [32%] of 31 control women. The difference was statistically significant [P=0, 0019]. antibodies to chlamydial hsp60 were significantly higher in TFI patients [28 of 45; 62%] than controls [6 of 31; 20%]. The difference was satistica1ly significant [P 0, 0002], Using the Spearman rank order correlation test, the antibodies chlamydial hsp6o had a highly significant correlation to C. trachomatis specific IgG antibodies in TFI patients [rs 0.53, P<0.001] and in controls [rs= 0.54, P<0.001]. In conclusion, Antibodies to chlamydial hsp60 and C. trachomatis-specific IgG are strongly associated with TFI a when used in combination at initial infertility evaluation, they would provide a rapid non-interventive means of diagnosing tubal factor infertility

Hysterosalpingographic accuracy of peritubal adhesion.

The purpose of this study was to determine diagnostic accuracy of hysterosalpingography by using different diagnostic criteria in peritubal adhesion diagnosis. The authors retrospectively reviewed cases in which both hysterosalpingography and laparoscopy were performed. Fifty-nine of 84 cases had laparoscopy proved peritubal adhesion. Five hysterosalpingographic signs (convoluted tube, vertical tube, ampullary dilatation, peritubal halo and loculation of the spillage of contrast material) defined by Karasick and Goldfarb were used to diagnose peritubal adhesion. All cases were analyzed by two different diagnostic criteria: first diagnostic criterion, presence of one or more signs means abnormal; second diagnostic criterion, presence of two or more signs means abnormal. Peritubal adhesion was diagnosed in 70 of 84 cases by using the first diagnostic criterion, 53 of 84 cases by using the second diagnostic criterion. The first diagnostic criterion displayed 94.9 per cent sensitivity, 44 per cent specificity, 80 per cent positive predictive value, 79.76 per cent accuracy and the likelihood ratio of 1.69. The second diagnostic criterion showed 74.6 per cent sensitivity, 64 per cent specificity, 83 per cent positive predictive value, 71.43 per cent accuracy and the likelihood ratio of 2.07. The authors conclude that using the 2nd diagnostic criterion is more appropriate than using the 1st diagnostic criterion in diagnosing peritubal adhesion.

Should hysteroscopy be used routinely at the time of laparoscopy for the investigation of infertility

This study included 265 infertile patients planned for laparoscopy, of whom 136 had primary and 129 had secondary infertility. Abnormal hysteroscopic and HSG findings were seen more in secondary than primary infertility. Abnormal findings were more frequent in hysteroscopy than in HSG cases. Forty-four cases with abnormal pathological intrauterine findings were not having previous HSG abnormalities. Out of these 44 patients, 39 had no history suggesting uterine lesion. The positive predictive values of HSG in endometrial polyp, submucous fibroid and intrauterine synechiae were 75, 77.8 and 85.7%, respectively. However, endometrial atrophy, endometrial hyperplasia, cervical polyp and cornual adhesions were detected only by hysteroscopy and not by HSG. Intrauterine synechiae were detected in 21 cases by HSG and 25 cases by hysteroscopy. HSG sensitivity = 72%, specificity = 98.8% and positive predictive value = 85.7%. Unilateral cornual block was detected in 5.66% by HSG, 4.53% by hysteroscopy and 4.15% by laparoscopy. Bilateral cornual block was detected in 11.32%, 9.81% and 8.68% by HSG, hysteroscopy and laparoscopy, respectively

Ultrasound hysterosalpingography as a preliminary infertility investigation

This study aimed to evaluate the diagnostic efficiency of transvaginal sonographic hysterosalpingography [HSG] for detection of tubal patency. Thirty-two women with unknown tubal patency undergoing routine infertility investigations were included in this study. Isotonic saline was injected into the uterine cavity through an endocervical catheter in the preovulatory phase of the cycle. X-ray HSG was performed on the next day and laparoscopy was carried out in the late secretory phase. Complete consistency with laparoscopic findings was found in 75% of cases using US-HSG compared with 81% by X-ray HSG [difference not significant]. Partial consistency was also demonstrated in insignificantly different proportions by the two techniques [12.5% versus 6.25%, respectively]. Complete inconsistency was found in similar proportions of cases [12.5%]. All parameters of diagnostic efficiency for US-HSG and X-ray HSG were not significantly different. It was concluded that ultrasound hysterosalpingography using isotonic saline with its safety and diagnostic efficiency is a promising technique for preliminary assessment of tubal patency in infertility patients. Its use may reduce the need for X-ray HSG and laparoscopy, particularly in case of demonstrating tubal patency

Hyterosalpingoscintigraphic [HSS] evaluation of fallopian tubes patency and physiology in normal and patients with unexplained infertility

In this work, 135 female patients with unexplained infertility as well as 45 age-matched controls were subjected to radionuclide HSS between day 9-16 of their menstrual cycles aiming to examine ovarian regulation on functional Fallopian tube patency in normal females, quantification of radiotracer Fallopian tubal transit time [TTT] in both normal and females with unexplained infertility and evaluation of functional Fallopian tube obstruction as a possible cause of unexplained infertility. HSS was done using 10 MBq 99 mTc- MAA of 5-40 um in diameter placed on posterior vaginal fornix. Serial anterior pelvic gamma camera images were obtained at five-minute intervals up to one hour and every 0.5 hour up to 4 hours. Delayed 24 hours images were taken if required. The results were related to the sonographically determined dominant follicle. Dominant follicle sided functional tubal patency was observed in 97% of normal with mean TTT 10 +/- 4 minutes as well as 40% of patients with their mean TTT 110 +/- 10 minutes. Functional Fallopian tube obstruction was observed in 60% of patients with unexplained infertility. The results indicated that HSS is a simple, noninvasive, sensitive and valuable method for evaluation of Fallopian tube patency and physiology in patients with unexplained infertility

Transvaginal sonographic histerohydrotubation versus hysterosalpingography in infertile women

Lipoidal hysterosalpingography [HSG] and vaginal sonographic histerohydrotubation [VSHT] were done in forty infertile women VSHT was done by transcervical injection of saline [20 - 50 ml] through a Foley's catheter [8 - 10] with sonographic detection of saline passage through the uterine cavity [expansion and decompression with turbulence] to be collected in Douglas pouch [tubal patency] VSHT versus HSG findings were bilateral patency [29 [72.5%] vs 26 [65%]], bilateral block [8 [20%] vs 10 [25%]], right block [2] [5%] for each] and left block [1 [2.5%] vs 2 [5%]], Sensitivity and negative predictive values of VSHT were 100% vs specificity was also above 90%, while the positive predictive value was ranged from 75% up to 80%, so VSHT is a useful diagnostic procedure in evaluation of tubal factor in problem of infertility

Comparative study between sonographic hydrotubation, hysterosalpingography and laparoscopy

This study was carried out on 36 infertile women with unknown tubal function. Sonographic hydrotubation [SHT] was done for every case before hysterosalpingography [[HSG], followed by laparoscopy to assess tubal function. Bilateral tubal patency was notied in 20 cass by SHT, 21 by HSG and 24 by laparoscopy. This shows that the results of SHT correlated with those of laparaoscopy, p< 0.05. Considering the incidence of unilateral tubal patency, no significant difference was found between SHT and laparoscopy. As regards the incidence of bilateral tubal obstruction, SHT detected 11, however, laparoscopy diagnosed only 6 at p< 0.05. SHT agreed in 25 cases of tubal patency out of 30 patients proved patent by laparoscopy [specificity 87.7%] at, p< 0.05. No patients with obstructed tubes were noted to have accumulated fluid in the cul-de-sac [sensitivity 100%]. Of the 36 patients who underwent preoperative HSG, 3 patients were noted falsely to be obstructed by SHT [specificity 90.9%], at p> 0.05. SHT detected only 5 cases of localized collection of fluid out of the 10 cases which proved to have pelvic adhesions by laparoscopy. In the course of SHT no serious side effects were noted. In conclusion, transvaginal sonography, seemed to be potentially safe, comvenient, less expensive, accurate and simple technique with potential advantage over HSG and it can be used as a screening procedure in demonstrating tubal patency

Aspects radiologiques de la pathologie utero-tubaire dans la sterilite feminine: a propos de 1314 hysterosalpingographies au CHU-Lome

1314 examens hysterosalpingographiques ont ete realises chez des femmes consultant pour sterilite secondaire et 25 pour cent une sterilite primaire. Les anomalies radiologiques observees sont dominees par les lesions uterines (53 pour cent) dont pres de la moitie representee par les sequelles traumatiques (27 pour cent). Les osbtructions tubaires representent 30 pour cent. 17 pour cent des femmes ont une hysterosalpingographie normale. La proportion elevee des sterilites secondaires; des lesions traumatiques uterines et des obstructions tubaires traduit la necessite de mettre en place des programmes de sante publique visant a sauvegarder la fecondite de la femme bien que les experts demographes parlent de l'Afrique en terme d'explosion demographique et de limitation des naissances

Hysteroscopy and hysterosalpingography

We present 58 cases of patients who had done hysterosalpingography and hysteroscopy to explore the uterine cavity. We conclude that, the results of these two exam's are the same in 74.1%. then the hysteroscopy only is suffisent to explore the cervical canal and the uterine cavity

Hysterosalpingography versus laparoscopy in infertile woman

This study was performed at AI-Hussein University Hospital, From Jan. 1989 to Jan. 1990, for the comparison of the results of hysterosalpingography [HSG] versus laparoscopy as copy as a diagnostic procedure in infertile women. One hundred and fourteen infertile women were selected after exclusion of any contraindication to HSG or laparoscopy. All women were investigated by HSG using lipiodol and by laparoscopy under general anaesthesia. According to the hysterosalpingographic results, the patients were classified into 2 groups: Group 1, included 18 women who had no abnormality by HSG while 15 out of them [83%] were found to have pathological findings on laparoscopy. Group 11 included 96 women who showed abnormal finding of HSG and 22 of them [23%] were found to be normal by laparoscopy. This study has proved that HSG and laparoscopy are complementary to each other for every inferile woman

Evaluación de la histosalpingografía radioisotópica / Evaluation of the radionuclide hysterosalpingography

En 22 pacientes, en control por esterilidad y en 6 mujeres sanas, se utilizó Histerosalpingografía Radioisotópica, comparando sus resultados con la Histerosalpingografía clásica y la Laparoscopía. Su empleo permite el diagnóstico de obstrucciones funcionales; reanastomosis y evaluación y evaluación de esterilización tubaria

Uterine ballonning: an unusual hysterosalpingraphic finding in cases of infertility

On interpertation of the hysterosalpingograhic studies for cases of infertility three types of uteine ballonning were observed. These functional uterine lesions include; the diffuse regular, diffuse irregular and comual types. A trial therapy with methergine tabelts daily during the five fertile days around the mid-cycle resulted in three pregnancies, an observation which suggests the hypotoncity of uterus resulting in such ballonning

Evaluation of selective salpingraphy technique in assessment of tubal patency

The authors modified the original hysterosalpingography technique to fit the clinical and operative need for a definite tubal patency test. They gave it the name "Selecitve Salpingography". They used a maliable polythene tube moulded to pass from the cervix to the uterotubal junction and they inject the contrast medium directly each tube while the patient is in the Trendelenberg's position. Tubal patency was proved by this technique in 92 out of 99 cases of unilateral obstruction and in 53 out of 81 cases of bilateral obstruction diagnosed by the conventional technique. This technique was particularly helpful to diagnose tubal patency in cases of severe cervical incompetence

value of hysteroscopy and hysterosalpingography in the evaluation of recurrent pregnancy losses

Fifty cases of repeated second trimester pregnancy losses were subjected to both hysterosalpingographic and hysteroscopic examination and the findings of both methods classified and compared to each other. Seventeen cases were diagnosed by both methods to have different types of congenital uterine anomalies. The two methods showed differences only In the diagnosis of the extent of the lesion. Four cases were diagnosed by hysteroscope to have intrauterine adhesions. This diagnosis was only presumptive when hysterosalpingography was used as the sole method of diagnosis. Three cases of submucous myomas were diagnosed by the hysteroscope but in only one case was the hysterosalpingogram shown to have a submucous fibromyoma. As regards patulous internal os, hysteroscopy was only a subjective method while hysterogram was an objective one

Al-Azhar experience with microsurgery for restoration of tubal patency

Thirty-five cases of tubal microsurgery were performed at Al-Azhar University Hospitals during the period November 1980 - 1982. All patients were followed up for assessment of tubal patency and the occurrence and outcome of pregnancy. Tubal patency was confirmed in 88% of the cases. Twenty patients were followed up for periods of six months and more. Pregnancy occurred in 8 patients [40%]. The paper describes in detail the profile of the patients included in the study, the technique and the factors which affect the results of the operation