Investigation of the uterine cavity and fallopian tubes using three-dimensional saline sonohysterosalpingography

Objective: to compare three-dimensional saline sonohysterosalpingography (S HSG) to X-ray hysterosalpingography (HSG) for the evaluation of the uterine cavity and fallopian tubes. Patient population: Fifteen infertile women on whom X-ray HSG had been performed within 1 year prior to this study. Metho d: Fifteen infertile women underwent three-dimensional power Doppler examin ation of the uterus and fallopian tubes with three-dimensional SHSG during the follicular phase. Distension was achieved using sterile saline injected through a 5 French HSG catheter. Peritoneal accumulation of free fluid sur rounding the ovary and tube was required for a diagnosis of a patent tube. Fluid accumulation in the cul-de-sac without visualization of the tubes was considered consistent with at least one tube being patent. Results: three- dimensional saline SHSG was completed in 14 patients. One patient had cervi cal stenosis and the procedure could not be performed. No significant intra uterine pathology was identified by either X-ray HSG or sonography. Three-d imensional saline SHSG made false positive diagnoses of tubal occlusion in four out of seven fallopian tubes (57%). The sensitivity and specificity fo r detecting tubal occlusion was 75 and 83%, respectively, with a positive p redictive value of 40% and negative predictive Value of 95%. Detection of f allopian tube architecture was not possible with three-dimensional saline S HSG in any patient. Simultaneous use of three-dimensional Doppler did not c learly identify the flow of saline through the fallopian tubes. Conclusions : transvaginal three-dimensional saline SHSG provides good visualization of the uterine cavity and myometrial walls in three orthogonal planes. Howeve r, it does not diagnose tubal occlusion or depict architecture of the fallo pian tube as accurately as X-ray HSG. Although we were able to visualize th e distal fallopian tube and fimbria with real-time imaging, we were not abl e to satisfactorily image the proximal tube with three-dimensional power Do ppler. This technique may be reserved as an initial screening test to evalu ate the uterine cavity and test patency. Patients at high risk for tubal di sease by history or with suspected tubal occlusion on three-dimensional sal ine SHSG should be evaluated by either X-ray HSG or laparoscopy with chromo pertubation. Further improvements of three-dimensional technology and contr ast materials will, it is hoped, make this method comparable to X-ray HSG. (C) 2001 Published by International Federation of Gynecology and Obstetrics .