Conventional and magnetic resonance hysterosalpingography in assessing tubal patency-A comparative study

Abstract

Context: Tubal factors, one of the leading causes of female infertility, have been conventionally evaluated by hysterosalpingography (HSG). The role of magnetic resonance imaging (MRI) in assessing female infertility is gaining importance because of its inherent efficiency in detecting structural abnormalities. Magnetic resonance hysterosalpingography (MR HSG) is less invasive and avoids exposure of ovaries to ionizing radiation. Its utility is extrapolated to visualize fallopian tubes.

Aims: To assess the diagnostic accuracies of dynamic MR HSG and conventional HSG (cHSG) in identifying tubal patency in women with infertility using diagnostic laparoscopy (DL) as gold standard.

Materials and methods: A prospective study of 40 patients was conducted over a period of 6 months. The patients were subjected to MR HSG followed by cHSG during the preovulatory period. If tubes were blocked, the patients were subjected to DL in the next menstrual cycle. If the tubes were patent and there was failure of conception, they were subjected to DL in the interval of 3 months.

Results: Twenty-four patients had bilateral tubal spill which was confirmed using cHSG and DL. One patient had discordant MR HSG and cHSG results and six patients had discordant MR HSG and DL results. No statistical difference was observed between MR HSG and cHSG.

Conclusion: Pelvic MRI is an inevitable tool in infertility evaluation. MR HSG can be used in addition as it avoids exposure of the reproductive organs to radiation and has the same efficacy as cHSG.

Keywords: Conventional hysterosalpingography; diagnostic laparoscopy; female infertility; magnetic resonance hysterosalpingography; tubal patency.

Figure 1 (A and B)

30 yrs old, P2L1, tubectomy done 5 years back, post tubal reanastamosis status, (A) MR HSG Subtracted images reformatted showing contrast within endometrial cavity and absence of peritoneal spill, reflux of contrast in the vagina, (B) Conventional HSG showing uterine cavity and bilateral tubal block

Figure 2 (A and B)

31 years old nullipara, (A) MR HSG Subtracted images reformatted showing contrast within endometrial cavity and bilateral peritoneal spill, (B) Conventional HSG showing uterine cavity and bilateral peritoneal spill

Figure 3 (A and B)

25 years old nullipara, the only case with discordant result between MR HSG and Conventional HSG, (A) MR HSG Subtracted reformatted image showing bilateral tubal block and (B) Conventional HSG shows right tubal spill and Type III intravasation of contrast

Figure 4 (A-C)

35 years old, P1L1, last child birth 10 years back, (A) MR T2W – hyperintense oblong cystic lesion in right adnexa with few internal septations mimicking right hydrosalphinx, (B) MR HSG Subtracted reformatted image showing bilateral tubes and distal block and no peritoneal spill, refluxed contrast in the vagina, (C) Conventional HSG showing bilateral fimbrial block and no peritoneal spill

Figure 5 (A and B)

25 years old, nullipara, (A) MR HSG Subtracted images showing contrast within endometrial cavity and left peritoneal spill and right tubal block, (B) Conventional HSG showing uterine cavity, left peritoneal spill, and right tubal block