Magnetic Resonance Hysterosalpingography Research Articles

Magnetic resonance imaging for non-invasive diagnosis of various forms of endometriosis in women with infertility

BACKGROUND: Endometriosis is one of the most common causes of infertility, affecting approximately 6%10% of women of reproductive age. For many decades, laparoscopic surgery has been considered the gold standard for diagnosing various forms of endometriosis. However, diagnostic laparoscopy, despite its widespread use, is an invasive and expensive procedure with certain risks. Current scientific literature increasingly shows that the methods of radiological diagnosis (ultrasound and magnetic resonance imaging [MRI]) are the main and most promising for verification of endometriosis. The advantages of MRI over ultrasound are multiplanar images, high tissue contrast, and smaller size of detectable heterotopias.
 AIM: To assessing the sensitivity and specificity of MRI for diagnosing different forms of endometriosis.
 METHODS: A retrospective analysis of the medical histories and instrumental studies of 129 women of reproductive age (mean age of the participants was 30.54.6 years) with a clinical diagnosis of infertility and suspected genital endometriosis was conducted. At the first stage of the study, the patients underwent a comprehensive MRI with one-stage magnetic resonance hysterosalpingography to assess the pelvis and tubal patency. Further, laparoscopic surgery (LS) was performed to confirm/refute the diagnosis of genital endometriosis, provide surgical treatment, or further search for possible causes of infertility. The results obtained with MRI and LS were compared, and the sensitivity and specificity of MRI for diagnosing external and internal genital endometriosis were assessed.
 RESULTS: According to the data obtained, the specificity of MRI for diagnosing peritoneal endometriosis was 74% (95% confidence interval [CI], 57%85%), and the sensitivity was 94% (95% CI, 87%99%). Diagnostic accuracy of the technique was 86% (95% CI, 79%91%). The most frequent localization of endometrioid heterotopias was retrocervical (41%). The specificity of this technique for diagnosing endometrioid ovarian cysts was 92% (95% CI, 82%97%), and the sensitivity amounted for 98% (95% CI, 90%100%). Diagnostic accuracy of the technique was 94% (95% CI, 88%96%). The specificity and sensitivity of MRI for the diagnosis of adenomyosis were 96% (95% CI, 92%99%) and 99% (95% CI, 87%100%), respectively. Diagnostic accuracy of the technique was 97% (95% CI, 93%99%). Our results were consistent with the literature data on the accuracy of MRI for diagnosing endometriosis.
 CONCLUSIONS: Based on the results, MRI is a promising non-invasive method for diagnosing various forms of endometriosis. The performance of a comprehensive MRI allows obtaining sufficiently accurate information about the condition of the pelvic organs, detecting the manifestations of genital endometriosis, and reducing the time for examining women with infertility.

Diagnostic role of magnetic resonance hysterosalpingography in the evaluation of female infertility

BackgroundIn the evaluation of female infertility, hysterosalpingography (HSG) with fluoroscopy provides limited evaluation of congenital uterine malformation and extrauterine disease. Transvaginal ultrasonography (TVS) is though commonly used, has its limitations in assessment of tubes. Addition of sonosalpingography can help assess tubal patency but may be inconclusive in cases of unilateral or bilateral obstruction and is grossly operator dependent. Recent past has seen evolution of magnetic resonance imaging (MRI) to evaluate problems associated with female infertility, with unparalleled advantages of having no radiation and being less operator-dependent. The need to assess tubal patency has been addressed by increasing literature on utilization of gadolinium (Gd) in MRI and comparing it with HSG alone or a mixture of HSG and laparoscopy. We aimed to evaluate the sensitivity and specificity of using magnetic resonance imaging (MRI) and magnetic resonance hysterosalpingography (MRHSG) as a screening test for female infertility and to compare accuracy, positive predictive value and efficacy of MRI and MRHSG with laparoscopy.ResultsFifty-four out of 63 patients had bilateral tubal patency (85.7%). Nine patients had tubal pathology (14.3%) out of which one had unilateral and eight had bilateral tubal obstruction. Endometrial cavity abnormality was found in four patients and ovarian abnormalities were detected in 28.5% patients. MRHSG has shown high sensitivity and specificity for tubal patency evaluation when compared to the true gold standard for tubal patency assessment, laparoscopic chromotubation. With laparoscopy as standard, there was 100% sensitivity and specificity for structural abnormality, myometrial abnormalities and endometrial cavity assessment in MRHSG.ConclusionsIn comparison with diagnostic laparoscopy, MRHSG was found to have good sensitivity and specificity for assessment of tubal patency, excellent sensitivity and specificity for the assessment of structural malformation and endometrial cavity lesions. Furthermore MRHSG was good in picking up extra-uterine diseases.

Comparation of magnetic resonance hysterosalpingography and hysterosalpingosonography for the assessment of fallopian tubal occlusion of female infertility: A protocol for systematic review and meta-analysis.

Objective:To evaluate the diagnostic performance of magnetic resonance hysterosalpingography (MR-HSG) for fallopian tubal occlusion in the context of female infertility when compared to the diagnostic performance of hysterosalpingosonography in evaluation of fallopian tubal occlusion of female infertility.Methods:We will search PubMed, Web of Science, Cochrane Library, and Chinese biomedical databases from their inceptions to the October 31, 2021, without language restrictions. Two authors will independently carry out searching literature records, scanning titles and abstracts, full texts, collecting data, and assessing risk of bias. Review Manager 5.2 and Stata14.0 software will be used for data analysis.Results:This systematic review will investigate whether MR-HSG has more diagnostic value than hysterosalpingosonography in evaluation of fallopian tubal occlusion of female infertility.Conclusion:Our meta-analysis indicated MR-HSG may serve as an alternative for further evaluation of fallopian tubal occlusion of female infertility.Systematic review registration:INPLASY2021110050.

Hysterosalpingo-foam sonography (HyFoSy) in the evaluation of tubal patency

Women’s infertility represents a public health issue as the birth rate in many countries is more and more diminished. At present, there are many investigation procedures for tubal patency with high accuracy that dictate the further management of infertility cases: hysterosalpingography, hysterosalpingo-contrast sonography, chromopertubation testing during laparoscopy (dye test), magnetic resonance-hysterosalpingography. The traditional gold standard in fertility investigation is represented by laparoscopy with chromopertubation testing, which carries the risk of surgical and anesthesia complications, being a procedure performed as inpatient and the costs are elevated. As ultrasonographic techniques advanced, there has been developed hysterosalpingo-foam sonography, a minimally invasive diagnostic procedure, with imperceptible risks or complications, which simultaneously imports valuable information about the uterine cavity and the tubal patency to the sonographer. Our aim in this paper is to present the statistical results existing in the literature concerning the accuracy of hysteronsalpingo-foam sonography (HyFoSy) in relation to the other examination methods, as well as its advantages.

Characteristics of magnetic resonance imaging and clinical etiology of ovarian infertility

Objective: To analyze the characteristics of magnetic resonance imaging (MRI) and clinical etiology of ovarian infertility. Methods: The data of infertile women who underwent 3.0T MRI and magnetic resonance hysterosalpingography (MR-HSG) examination in the Affiliated Hospital of Nanjing University of Chinese Medicine from September 2017 to March 2020 were collected. The ovarian factors of infertility, as well as the abnormalities of bilateral fallopian tubes and uterus, were evaluated. Etiologies assessed by MRI were finally confirmed by hysteroscopy, laparoscopy, surgery, or a comprehensive clinical diagnosis. Results: Among 1 351 patients, 1 296 cases were eligible and included for further analysis. Evaluated by MRI and MR-HSG, 494(38.12%) cases had ovarian abnormalities, including 239(48.38%) cases of ovarian endometriosiss, 116(23.48%) cases of polycystic ovary syndrome (PCOS), 37(7.49%) cases of diminished ovarian reserve (DOR), 33(6.68%) cases of ovarian mass, 28(5.67%) cases of ovarian injury, and 41(8.30%) cases who had at least two kinds of ovarian diseases. Unilateral and bilateral ovarian abnormalities accounted for 52.02% (257/494) and 47.98%(237/494), respectively.In total, 453 of 494(91.7%) patients had only one kind of ovarian disease. Among the 494 patients, 103(20.85%) cases had abnormal ovary with normal uterus and fallopian tubes, and the other 391(79.15%) cases had abnormalities not only in ovary, but in fallopian tube and/or uterus. Conclusion: Infertility-related ovarian diseases have certain characteristics of MRI findings. 3.0T MRI is useful for comprehensive analysis of etiology in ovarian infertility. Combined with MR-HSG, it provides one-stop assessments of the pelvic factors in female infertility.

Hysterosalpingo-contrast-sonography vs. magnetic resonance-hysterosalpingography for diagnosing fallopian tubal patency: A systematic review and meta-analysis

PurposeTo compare hysterosalpingo-contrast-sonography (HyCoSy) and magnetic resonance-hysterosalpingography (MR-HSG) in the diagnosis of fallopian tubal patency. Materials and methodsThe databases of PubMed, Embase, and the Cochrane Library were searched for records up to November 30, 2019. Studies involved in the diagnostic detection of HyCoSy or MR-HSG for fallopian tubal patency using conventional HSG or laparoscopy as the reference test were included. Data was analyzed by meta-analysis. We compared sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR), diagnostic odds ratio (DOR), and summary receiver operating characteristic (sROC) plots of both HyCoSy and MR-HSG. Quality was assessed using the QUADAS-2 tool. ResultsThe analysis included 24 articles involving 1340 patients. HyCoSy was studied in 17 studies, and MR-HSG was studied in seven studies. For HyCoSy in diagnosis of fallopian tubal patency, pooled sensitivity was 89 % (95 % confidence interval [CI], 87 %–91 %), and specificity was 93 % (95 % CI, 91 %–94 %). For MR-HSG in diagnosis of fallopian tubal patency, pooled sensitivity was 100 % (95 % CI, 98 %–100 %), and specificity was 82 % (95 % CI, 74 %–89 %). The sROC showed similar diagnostic accuracy for MR-HSG and HyCoSy. 3D/4D HyCoSy with ultrasound microbubbles had equal sensitivity (95 % vs. 100 %, P = 0.186) and significantly higher specificity (94 % vs. 82 %, P = 0.005) compared with MR-HSG. ConclusionsHyCoSy and MR-HSG showed similar overall diagnostic performance for diagnosing fallopian tubal patency. 3D/4D HyCoSy with ultrasound microbubbles could significantly improve the diagnostic specificity of HyCoSy.

The role of 3.0 T MR hysterosalpingography work-up in the diagnosis of female infertility

Objective To evaluate the role of 3.0 Tesla magnetic resonance hysterosalpingography (MR-HSG) work-up in the diagnosis of female infertility. Methods Between July 2015 and December 2018, a total of 1 052 infertile women aged from 20 to 40 years in the Affiliated Hospital of Nanjing University of Chinese Medicine were prospectively enrolled in the study. All the patients underwent pelvic plain scanning and X-ray hysterosalpingography (HSG) followed by MR-HSG examination, and the patency of the fallopian tubes as well as the abnormalities of the uterus and ovaries were evaluated. Among which 33 cases were randomly selected. The chi-square test and Kappa test were used to compare the difference and the consistency of the two methods in the evaluation of fallopian tubes. Results MR-HSG and HSG had good consistency in evaluating tubal patency (Kappa=0.88, P<0.01), and there was no statistically significant difference between the two groups (P=0.65). The examination of MR-HSG was successfully completed in 97.1%(1 021/1 052) cases. There were 81.7% (834/1 021) cases had at least one abnormality. Bilateral tubal, uterine and ovarian abnormalitiesoccurred in 42.6% (435/1 021), 34.2% (349/1 021)and 46.8% (478/1 021) cases, respectively. In which tubal abnormalities display the results as follows: bilateral obstructed 4.7% (48/1 021), bilateral poor pass 8.5% (87/1 021), one smooth one obstructed11.7% (119/1 021), one smooth one poor pass 12.6% (129/1 021), and one poor pass one obstructed 5.1% (52/1 021). Conclusion 3.0 T MR-HSG is expected to be a routineexam for evaluating female infertility, which allows a comprehensive assessment of tubal patency and other pelvic abnormalities of infertile women. Key words: Female infertility; Fallopian tube; Magnetic resonance imaging; Hysterosalpingography

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

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.

A comparative study of conventional and magnetic resonance hysterosalpingography in assessing tubal patency at a tertiary care center

A comparative study of conventional and magnetic resonance hysterosalpingography in assessing tubal patency at a tertiary care center

Magnetic resonance hysterosalpingography in diagnostic work-up of female infertility - comparison with conventional hysterosalpingography: a randomised study.

To compare diagnostic accuracy of MR-hysterosalpingography (MR-HSG) and conventional hysterosalpingography (X-HSG) in the evaluation of female infertility. Forty women received prospectively both X-HSG, the gold standard technique, and MR-HSG on the same day but the order in which they were conducted was randomised. A 1.5 Tesla MRI was performed with classical sequences for pelvic analysis and an additional 3D T1-weighted sequence with intra-uterine injection of gadolinium. Two radiologists independently interpreted X-HSG and MR-HSG according to randomisation, blinded to the other results. They both then performed a second interpretation of MR-HSG blinded to the first reading with a minimum time delay of 1 week. Diagnostic performance of MR-HSG for analysis of tubal and intracavity abnormalities was evaluated by calculating sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV). Twenty-six patients were included. Diagnostic performance of MR-HSG was: Se: 91.7% (95% CI 61.5-99.8); Sp: 92.9% (95% CI 66.1-99.8) ; PPV: 91.7% (95% CI 61.5-99.8); NPV: 92.9% (95% CI 66.1-99.8). Pain analysis showed a significant statistical difference between the two procedures: average VAS for X-HSG was 4.43 (95% CI 3.50-5.36) versus 3.46 (95% CI 2.62-4.31) for MR-HSG, p=0,01. Intra- and inter-rater agreements for detection of tubal or intracavity abnormalities were 0.92 (95% CI 0.78-1.00) and 0.76 (95% CI 0.52-1.00). MR-HSG is a well-tolerated technique demonstrating high accuracy in investigating tubal patency and intra-uterine abnormalities for diagnostic work-up of female infertility. • MR-hysterosalpingography is an innovative technique. • Hysterosalpingography can be used to investigate tubal patency and intracavity abnormalities. • Hysterosalpingography is a potential 'one-stop-shop' imaging technique for a single comprehensive examination of female infertility.

Rendimiento diagnóstico de la histerosalpingografía por resonancia magnética: resultados iniciales

ObjectiveTo determine the diagnostic performance of magnetic resonance hysterosalpingography (MRHSG) using laparoscopic chromotubation as a method of reference. Materials and methodsTwenty-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. ResultsMRHSG had a 91% success rate. Exam duration of the examination was 49±15min, with an injected volume 26±16cc, and pain scale 30±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. DiscussionThe 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%. ConclusionMRHSG is a feasible and safe alternative to conventional or virtual HSG, ultrasound-hysterography and chromotubation.

Role of 3.0 Tesla magnetic resonance hysterosalpingography in the diagnostic work-up of female infertility.

Imaging evaluation plays a crucial role in the diagnostic work-up of female infertility. In recent years, the possibility to evaluate tubal patency using 1.5 Tesla magnetic resonance (1.5T MR) has been studied. To assess the feasibility of 3.0 Tesla magnetic resonance (3.0T MR) hysterosalpingography and its role in the diagnostic work-up of female infertility and to evaluate if this fast "one-stop-shop" imaging approach should be proposed as a first-line examination. A total of 116 infertile women were enrolled in this prospective study; all underwent 3.0T MR hysterosalpingography. After standard imaging of the pelvis, tubal patency was assessed by acquiring 3D dynamic time-resolved T1-weighted (T1W) sequences during manual injection of 4-5 mL of contrast solution consisting of gadolinium and normal sterile saline. Images were evaluated by two radiologists with different experience in MR imaging (MRI). The examination was successfully completed in 96.5% of cases, failure rate was 3.5%. Dynamic sequences showed bilateral tubal patency in 64.3%, unilateral tubal patency in 25.9%, and bilateral tubal occlusion in 9.8%. Extratubal abnormalities were found in 69.9% of patients. Comprehensive analysis of morphological and dynamic sequences showed extratubal abnormalities in 43.1% of patients with bilateral tubal patency. 3.0T MR hysterosalpingography is a feasible, simple, fast, safe, and well-tolerated examination, which allows evaluation of tubal patency and other pelvic causes of female infertility in a single session, and it may thus represent a "one-stop-shop" solution in female infertility diagnostic work-up.

Imaging pelvic inflammatory disease

Pelvic inflammatory disease (PID) encompasses a range of infections of the female genital tract that may be asymptomatic, or range from mild non-specific symptoms to fulminant life-threatening disease. Infection can involve the endometrium, fallopian tubes or ovaries and can occasionally spread to involve the peritoneum. Mostly PID is diagnosed clinically and treated without the need for imaging. Where imaging is required, it is mainly for the assessment of non-specific clinical symptoms and signs in which PID is a differential diagnosis, or for the complications of more severe PID infections. The high resolution of ultrasound makes it highly sensitive for the evaluation of the gynaecological organs including the fallopian tubes when abnormal, and is usually the first imaging investigation obtained. Other types of imaging including computed tomography, magnetic resonance imaging and hysterosalpingography are also used, mainly in more complex cases. The imaging appearances of PID on all modalities are discussed in this review to obtain an overall picture of imaging this disease.

The reproductive tract

Diagnostic imaging has played a major role in the evaluation of patients with the cancers of the reproductive tract. The imaging modalities have included ultrasonography, computed tomography, magnetic resonance imaging, hysterosalpingography, and scintigraphy with radiolabeled monoclonal antibodies. Positron emission tomography (PET) with [F-18]fluorodeoxyglucose also has been shown to be useful in the imaging evaluation of these patients. Clinical applications have included initial staging and posttherapy restaging of disease, detecting metastatic disease, differentiating posttherapy anatomic alterations from recurrent or residual disease, and predicting and evaluating treatment response. In this article, we review the diagnostic utility of dedicated PET and combined PET-computed tomography systems in the imaging assessment of reproductive tract malignancies (excluding prostate cancer) in both sexes with an emphasis on fluorodeoxyglucose applications.

MR hysterosalpingography: protocol development and refinement for simulating normal and abnormal fallopian tube patency--feasibility study with a phantom.

To develop and refine a pulse sequence and protocol for testing the feasibility of magnetic resonance (MR) hysterosalpingography in a phantom model. A phantom simulating the uterus, fallopian tubes, and surrounding pelvic cavity was constructed. T2-weighted acquisition strategies-breath-hold fast spin-echo, rapid acquisition with relaxation enhancement (RARE), and haff-Fourier RARE-were refined to acquire sequential 70-mm coronal imaging volumes. Contrast agent was injected into the introducing catheter entering the os of the simulated uterus. Interacquisition interval, type of contrast agent (eg, sterile saline solution or water), and quantity of contrast agent (eg, 1-5 mL per acquisition) were varied. Digital image subtraction was used to enhance image quality. Images were qualitatively analyzed and rated good, fair, or poor for temporal resolution, spatial resolution, fallopian tube conspicuity, and free spill conspicuity. Once the technique was refine, the phantom was reconfigured to simulate unilateral and bilateral hydrosalpinx. The RARE sequence with an 8-second interacquisition interval and a 5-mL interacquisition of sterile water produced good images of the simulated fallopian tubes and free spill. Depiction of unilateral and bilateral hydrosalpinx was also reliably demonstrated. This study with a phantom model demonstrates the feasibility of MR hysterosalpingography to depict normal and diseased fallopian tubes.

Magnetic resonance hysterography and hysterosalpingography using hyperpolarized (3)He: demonstration of feasibility in an animal model.

Assessment of the uterine cavity and patency of the fallopian tubes remains a difficult goal with magnetic resonance imaging (MRI). The purpose of this paper is to describe the development of a new magnetic resonance hysterography (MR-HG) and hysterosalpingography (MR-HSG) technique employing hyperpolarized (3)He. Two-dimensional (2D) and 3D gradient-echo imaging sequences were developed and optimized using a phantom. An optimized sequence was then applied in swine cadavers. J. Magn. Reson. Imaging 2000;12:1009-1013.

Initial results of magnetic resonance hysterosalpingography diagnostic performance

Objective: to determine the diagnostic performance of magnetic resonance hysterosalpingography (HSG-MRI), using laparoscopy as the reference method. Materials and methods: 22 patients were included. All underwent HSG-MRI with a 1.5 Tesla resonator and then laparoscopy with chromotubation. Two radiologists examined the MRIs, determining tubal patency by consensus. Descriptive and diagnostic performance analyses were performed. Results: HSG-MRI had a success rate of 91%. Study duration was 49 ± 15 minutes, volume injected 26 ± 16 cm3 and pain scale 30 ± 19 out of 100. Sensitivity and specificity of HSG-MRI were 100% for global and left Cotte test, and 25% and 93.3% for right Cotte test, respectively. There were 2 minor complications and no major complications. Discussion: our initial results demonstrated high sensitivity and specificity. Although other studies analyzed the ability of HSG-MRI to assess tubal patency with good results, the use of a flawed reference standard left room for reasonable doubt, preventing a recommendation based on solid evidence. However, when comparing our results with those published, we observed a high degree of concordance insofar as the positive effusion is correctly diagnosed with a specificity of 100% or with a percentage close to this figure.