CT virtual hysterosalpingography in the evaluation of intrauterine adhesions

Abstract

OBJECTIVE: Evaluation of the uterus with CT Virtual Hysterosalpingography (VHSG) provides a more complete, less invasive evaluation of the uterus with 2D, 3D and endoscopic views. The objective of this paper is to show the role of VHSG in the evaluation of intrauterine adhesions and to show the different image characteristics that these lesions can present by this procedure. DESIGN: Descriptive retrospective study. MATERIALS AND METHODS: 790 patients with diagnosis of infertility performed a VHSG with a 64-row CT scanner with slices of 0.9 mm thickness, 0.45 mm reconstruction interval, 120 kV and 100-150 mAs. The mean scan time was 4 seconds. Twenty milliliters of a diluted contrast (3ml of iodine contrast and 17ml of saline solution) were injected into the uterine cavity through a fine catheter. CT images were evaluated on a workstation using multiple post-processing techniques including multiplanar reconstructions, maximum intensity projections, volume rendering and virtual endoscopic images. CT images were evaluated for the presence of intrauterine linear filling defects that were considered as intrauterine adhesions (synechiaes) and classified as focal or diffuse according to the area of the uterus involved. RESULTS: Synechiaes were observed in 55 of the 790 patients studied (7%). From the 55 patients with intrauterine synechiaes, 12 had history of ectopic pregnancy, 27 of abortion and 16 of surgical treatments. Focal adhesions were observed in 35/55 (63.7%) whereas diffuse adhesions were detected in 20/55 (36.3%). Multiplanar reconstructions and maximum intensity projections were useful in the evaluation of this pathology. However synechiaes were better visualized using volume rendering and virtual endoscopy views. Both of them gave a precise localization as well as extension of the disease. CONCLUSION: VHSG is a useful modality to evaluate the presence of intrauterine adhesions. Volume rendering and virtual endoscopy images gave a precise diagnosis of extension and localization of this pathology.