Hysterosalpingography using Magnetic Resonance Imaging for infertility patients

Abstract

Objective: Some studies have shown that it is possible to evaluate tubal permeability through MRI. Our aim is to perform a prospective study and to perform a comprehensive review in the literature regarding HSG-MRI.

Methods: We carried out a PUBMED search using the following keywords: hysterosalpingogram, hysterosalpingography, magnetic resonance imaging and MRI. As inclusion criteria, we included only papers published in English, and exams ran on humans. We also conducted a prospective inclusion of patients who had visited a human reproduction clinic between May/2017 and April/2019 for laboratory image diagnoses using HSG-MRI.

Results: Following the inclusion and exclusion criteria, we included seven original papers. Review papers and those written in a language other than English, were excluded. Between the period of May/2017 and April/2019, we selected ten patients for our study. The average exam duration was 30 minutes. Cervical catheterization was possible in all cases. There were no major complications. We highlight that in 8/9 of patients, we could directly visualize uterine tubes with contrast (excluding one patient with bilateral tubal ligation).

Conclusions: Our initial experience with HSG-MRI shows promise. We demonstrated an optimized protocol for conducting an HSG-MRI (with excellent image quality). HSG-MRI had some advantages, such as not using ionized radiation, less pain and being able to analyze pelvic anatomy. Patients referred for a pelvic MRI as part of a more detailed investigation into infertility can also benefit from undergoing a simultaneous HSG using MRI.

Keywords: Hysterosalpingography; Image; Magnetic Resonance Imaging; Tubal factor Infertility; infertility.

Figure 1

MR-HSG equipment A: MR-HSG equipment. Black circle: end of the catheter with the balloon that will be placed in the uterine cervix. Blue circle: syringe used to inflate the catheter. Yellow: syringe used to inject the contrast medium (gadolinium + saline). B and C illustrate items used: black arrows indicate the plastic speculum (MR compatible). The white circle shows the light connector for better view of the external orifice of the uterine cervix. White arrows show the HSG equipment as it is introduced in the vagina. D: patient positioned at the MR table as the radiologist administers the contrast medium.

Figure 2

Exam example A: MR T2WI in the axial plane. The circles show ovaries close to the midline in the posterior pelvic pouch and adhered to the retrouterine endometriotic tissue. B: T2WI in the coronal plane. The yellow arrow shows a small submucosal fibroid measuring 3 mm; the white arrow indicates retrouterine endometriosis with adhesions involving both the ovaries and the rectum. C: Dynamic MR-HSG sequence in the axial plane. White arrows show bilateral hydrosalpinx with mucosal thickening. D: The circle shows right tube accumulated in the posterior pelvic pouch. E: MR-HSG volume rendering showing bilateral hydrosalpinx. F: Conventional HSG with bilateral hydrosalpinx.

Figure 3

Exam example A: T2WI in the axial plane showing no abnormalities. B: Dynamic MR-HSG in axial plane. The circle shows part of the right tube, normal appearing. C: Dynamic MR-HSG axial plane. The arrow shows the uterine cavity filled with contrast and the circle indicates free tubal spillage to the peritoneal cavity. D: Dynamic MR-HSG in the sagittal plane. The arrow demonstrates the left ovary with a small amount of adjacent fluid. The circle shows a small amount of fluid in the left ovarian fossa. E: Conventional HSG showing normal tubes (circles). F: Conventional HSG, late phase (Cotté). The arrows demonstrate normal contrast dispersion in the peritoneal cavity. The circle shows periovarian fluid.