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Heuser GG, Medeiros TM, Heuser HG, Scopel KRO, Battisti IDE, Hochhegger B, Winkelmann ER. Diagnostic accuracy of pelvis multiparametric MRI against CT virtual hysterosalpingography: a prospective study of tubal patency through female infertility assessment. Br J Radiol 2023; 96:20220889. [PMID: 37066809 PMCID: PMC10230390 DOI: 10.1259/bjr.20220889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 03/03/2023] [Accepted: 03/20/2023] [Indexed: 04/18/2023] Open
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of MRI-hysterosalpingogram (HSG) with semiquantitative dynamic contrast-enhanced perfusion, against the virtual multislice CT hysterosalpingogram (VHSG) as a reference standard. METHODS AND MATERIALS In this prospective study, 26 women (age >18 years) searching for infertility causes and with VHSG physician request. Thereafter, the assessment performance of both techniques was determined by two reader analyses. k statistics were used for the assessment of tubal patency. Receiver operating characteristic (ROC) analysis was used to compare the capability for tubal patency assessment between both exams on a per-patient and per-tube basis. The McNemar test was used to compare the diagnostic accuracy measures. RESULTS Tubal patency, uterine morphological, ovarian, and extrauterine abnormalities were evaluated through both exams in all 26 women. There was no significant difference between diagnostic performance measurements between the methods. The ROC curve of VHSG was 0.852 for both per-patient and per-tube analyses, and one and 0.938 for MRI-HSG. Sensitivity and specificity for per-patient and per-tube for VHSG were 95.2 and 97.7, 80 and 87.5%, and for MRI-HSG 100% for both analyses and 100 and 87.5%, respectively. CONCLUSION This study demonstrates the feasibility of diagnosing tubal patency through MRI, using a semi-quantitative dynamic contrast-enhanced perfusion sequence, and the satisfactory diagnosing of the uterine morphology, ovarian abnormalities, and ovarian and deep endometriosis. ADVANCES IN KNOWLEDGE Multiparametric MRI with a perfusion real-time sequence as a HSG method can be used in the evaluation not only for uterine and ovarian abnormilities but also tubal patency.
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Affiliation(s)
| | | | | | | | - Iara Denise Endruweit Battisti
- Master's Program in Public Policy and Development and the Master's Program in Environment and Sustainable Technologies, Federal University of the Southern Frontier de Cerro Largo, Cerro Largo, RS, Brazil
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Mattos LAD, Sauer LJ, Blasbalg R, Petta CA, Pereira RM, Carvalho LFPD. Hysterosalpingography using Magnetic Resonance Imaging for infertility patients. JBRA Assist Reprod 2021; 25:403-411. [PMID: 33900058 PMCID: PMC8312299 DOI: 10.5935/1518-0557.20210002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 01/04/2021] [Indexed: 11/25/2022] Open
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.
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Affiliation(s)
- Leandro Accardo de Mattos
- ALTA Excellency Diagnostic/DASA Department of Diagnostic Imaging/DASA, São Paulo Brazil
- Department of Diagnostic Imaging, Federal University of São Paulo, São Paulo, Brazil
| | - Luísa Jacques Sauer
- ALTA Excellency Diagnostic/DASA Department of Diagnostic Imaging/DASA, São Paulo Brazil
| | - Roberto Blasbalg
- ALTA Excellency Diagnostic/DASA Department of Diagnostic Imaging/DASA, São Paulo Brazil
| | | | | | - Luiz Fernando Pina de Carvalho
- Baby Center - Center for Reproductive Medicine, São Paulo, Brazil
- College - Institute of Clinical Research and Teaching Development, São Paulo, Brazil
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Castro PT, Aranda OL, Marchiori E, Araújo LFBD, Alves HDL, Lopes RT, Werner H, Araujo Júnior E. Proportional vascularization along the fallopian tubes and ovarian fimbria: assessment by confocal microtomography. Radiol Bras 2020; 53:161-166. [PMID: 32587423 PMCID: PMC7302899 DOI: 10.1590/0100-3984.2019.0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate and reconstruct three-dimensional images of vascularization along the fallopian tube (FT), as well as to determine its relationship with the ovary and ovarian fimbria, and to quantify the blood vessels along the FT according to its anatomical segments, using confocal microtomography (micro-CT). Materials and Methods Nine specimens (six FTs and three FTs with ovaries) were fixed in a solution of 10% formalin for > 24 h at room temperature. Iodine staining was performed by soaking the specimens in 10% Lugol’s solution for 24 h. All specimens were evaluated using micro-CT. A morphometric analysis was performed on the reconstructed images to quantify the vascular distribution along the FT. Results In the FTs evaluated, the density of blood vessels was significantly greater in the fimbrial segments than in the isthmic segments (p < 0.05). The ovarian fimbria was clearly identified, demonstrating the important relationship between these vessels and the FT fimbriae. Conclusion We believe that the vascularization in the fimbriae is greater than and disproportional that in the other segments of FT, and that the ovarian fimbria plays an important role in the development of that difference.
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Affiliation(s)
- Pedro Teixeira Castro
- Universidade Federal do Rio de Janeiro (UFRJ), Brazil; Clínica Diagnóstico por Imagem (CDPI), Brazil
| | - Osvaldo Luiz Aranda
- Universidade Federal do Rio de Janeiro (UFRJ), Brazil; Universidade de Vassouras, Brazil
| | | | | | - Haimon Diniz Lopes Alves
- Universidade Federal do Rio de Janeiro (UFRJ), Brazil; Universidade do Estado do Rio de Janeiro (UERJ), Brazil
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Merritt BA, Behr SC, Khati NJ. Imaging of Infertility, Part 1: Hysterosalpingograms to Magnetic Resonance Imaging. Radiol Clin North Am 2020; 58:215-225. [PMID: 32044003 DOI: 10.1016/j.rcl.2019.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Infertility, or subfertility, is the inability to achieve a clinical pregnancy after a 1-year period of regular unprotected sexual intercourse in women younger than 35 and after 6 months in women older than 35. Although initial assessment involves a multitude of factors, including a detailed medical history, physical examination, semen analysis, and hormonal evaluation, diagnostic imaging of the female partner often plays an important role in establishing the etiology for infertility. This article provides an overview of the multimodality imaging assessment of female infertility and details the developmental and acquired pelvic abnormalities in which diagnostic imaging aids in evaluation.
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Affiliation(s)
- Bryce A Merritt
- Diagnostic Radiology, UCSF Department of Radiology & Biomedical Imaging, 505 Parnassus Avenue, Moffitt, Suite 307H, San Francisco, CA 94143, USA
| | - Spencer C Behr
- UCSF Department of Radiology & Biomedical Imaging, 505 Parnassus Avenue, Moffitt, Suite 307H, San Francisco, CA 94143, USA
| | - Nadia J Khati
- Department of Radiology, Abdominal Imaging Section, The George Washington University Hospital, 900 23rd Street, Northwest, Washington, DC 20037, USA.
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The human endosalpinx: anatomical three-dimensional study and reconstruction using confocal microtomography. Pol J Radiol 2019; 84:e281-e288. [PMID: 31482002 PMCID: PMC6717942 DOI: 10.5114/pjr.2019.86824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/07/2019] [Indexed: 12/21/2022] Open
Abstract
Purpose To evaluate in three dimensions (3D) the human endosalpinx and reconstruct its surface
along its different anatomical segments, without the injection or insertion of luminal
contrasts, using confocal microtomography (micro-CT). Material and methods 15 fallopian tubes (FT) from 14 women in reproductive age from procedures for benign
disease or sterilization were selected. The specimens were fixed in formalin and stained
with Lugol solution. Micro-CT studies were conducted on the specimens using protocols
adapted from biological studies, to acquire images to reconstruct in 3D the endosalpinx
surface. Results From these specimens, 6 presented the intra-mural segment, 14 presented the isthmus and
15 presented the ampulla and fimbria segment of the FT. The specimen presented tissue
definition, and contrast sufficient for FT endosalpinx morphological analysis and lumen
definition. The intramural portion presented initially a mucosal projection toward the
lumen, bending on its own axis, and increased numbers of projections towards the isthmic
portion, where the projections become longer more numerous. The endosalpinx becomes more
tortuous, the lumen diameter increases and the mucosal projections become more bulky in
the ampullary portion, with the projections less present on the antimesenteric side. The
infundibular portion is marked with the organized and predictable endosalpinx, the
abdominal ostium is cleared demonstrated, with the reduction of the endosalpinx volume.
The fimbria demonstrated a small relation between fringes and intratubal
endosalpinx. Conclusions Microscopic anatomy of different segments of the human FT mucosa can be analyzed and
reconstructed in 3D with histological correlation using micro-CT.
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Volondat M, Fontas E, Delotte J, Fatfouta I, Chevallier P, Chassang M. Magnetic resonance hysterosalpingography in diagnostic work-up of female infertility – comparison with conventional hysterosalpingography: a randomised study. Eur Radiol 2018; 29:501-508. [DOI: 10.1007/s00330-018-5572-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/17/2018] [Accepted: 05/28/2018] [Indexed: 11/24/2022]
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Castro PT, Matos APP, Aranda OL, Marchiori E, Alves HDL, Machado AS, Lopes RT, Werner H, Araujo Júnior E. Tuboperitoneal fistula, ectopic pregnancy, and remnants of fallopian tube: a confocal microtomography analysis and 3D reconstruction of human fallopian tube pathologies. J Matern Fetal Neonatal Med 2018; 32:3082-3087. [PMID: 29558232 DOI: 10.1080/14767058.2018.1455181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: The aim of this study was to provide a three-dimensional (3D) microscopic reconstruction of morphological modifications of the fallopian tube (FT) following surgical sterilization (including tuboperitoneal fistula) and ectopic pregnancy (EP) using confocal microtomography (micro-CT). Methods: Six specimens of FT from elective and emergency surgeries were selected: three remnants of the FT (RFT) from surgical sterilization, including one presenting tuboperitoneal fistula, and three FTs with EP. The specimens were fixed in formalin and stained with Lugol solution. Micro-CT studies were conducted on the specimens using protocols adapted from biological studies. Results: Three RFTs from surgical sterilization and three FTs affected by EPs were successfully scanned using micro-CT. There was good contrast impregnation, allowing tissue segmentation and analysis of different sections of the FTs. Three FT specimens from EP exhibited considerable distortion of the tubal anatomy, mainly from the blood clot in the tubal abortion. Three RFT specimens exhibited some features observed in traditional microscopy, such as tubal distension and loss of normal anatomical characteristics of a normal FT, and indicated the presence of a tuboperitoneal fistula in one of the three specimens. Conclusion: Micro-CT can identify morphological characteristics of FT pathologies previously described in a microscopic scale, with tissue contrast and the possibility of 3D reconstruction. Micro-CT is also useful in guiding traditional sectioning of specimens for histopathological studies.
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Affiliation(s)
- Pedro Teixeira Castro
- a Department of Radiology , Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil.,b Department of Radiology , Clínica Diagnóstico por Imagem (CDPI) , Rio de Janeiro , Brazil
| | - Ana Paula Pinho Matos
- b Department of Radiology , Clínica Diagnóstico por Imagem (CDPI) , Rio de Janeiro , Brazil
| | - Osvaldo Luiz Aranda
- a Department of Radiology , Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil.,c Department of Obstetrics and Gynecology , Vassouras University , Vassouras , Brazil
| | - Edson Marchiori
- a Department of Radiology , Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil
| | - Haimon Diniz Lopes Alves
- d Department of Applied Physics and Thermodynamics , Physics Institute, State University of Rio de Janeiro (UERJ) , Rio de Janeiro , Brazil.,e Nuclear Engineering Program (PEN/COPPE), Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil
| | - Alessandra Silveira Machado
- e Nuclear Engineering Program (PEN/COPPE), Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil
| | - Ricardo Tadeu Lopes
- e Nuclear Engineering Program (PEN/COPPE), Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil
| | - Heron Werner
- b Department of Radiology , Clínica Diagnóstico por Imagem (CDPI) , Rio de Janeiro , Brazil
| | - Edward Araujo Júnior
- f Department of Obstetrics, Paulista School of Medicine , Federal University of São Paulo (EPM-UNIFESP) , São Paulo , Brazil
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Virtual ultrasonographic hysteroscopy followed by conventional operative hysteroscopy, enabling pregnancy. Am J Obstet Gynecol 2017; 216:188.e1. [PMID: 27640941 DOI: 10.1016/j.ajog.2016.09.081] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/04/2016] [Accepted: 09/07/2016] [Indexed: 10/21/2022]
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