Automated sonographic tubal patency evaluation with three‐dimensional coded contrast imaging (CCI) during hysterosalpingo‐contrast sonography (HyCoSy)

Abstract

Evaluation of tubal status is one of the initial steps in the diagnostic work-up of infertile women. Hysterosalpingo- contrast sonography (HyCoSy), currently performed as part of the infertility work-up to assess tubal patency by transvaginal ultrasound (TVS) 1 , is based on the introduction of fluid into the uterine cavity and Fallopian tubes. To evaluate the Fallopian tubes, a sonographic enhancing positive-contrast medium may be used. Air, albumin with micro air bubbles, and galactose with micro air bubbles have been studied. These positive- contrast agents outline the course of the Fallopian tubes, producingahyperechoicappearance.Themostsimpleand inexpensive positive-contrast medium is saline solution mixed with air. When this solution is shaken, it generates as uspension of air bubbles that is easily identif ied sonographically when injected into the uterine cavity and Fallopian tubes 2-4 with spillage around the ovaries. However, while two-dimensional (2D) TVS HyCoSy with saline solution mixed with air appears to be an accurate and inexpensive screening tool to assess tubal patency, it is highly observer-dependent and is accurate only in the hands of experienced investigators 2-5 . In addition,