Development of a Nomogram for Predicting Intravasation Before Transvaginal 4-Dimensional Hysterosalpingo-Contrast Sonography

Abstract

Background Intravasation during transvaginal 4-dimensional hysterosalpingo-contrast sonography (TVS 4D-HyCoSy) may lead to false-negative results in tubal patency evaluation. Although the influencing factors associated with intravasation have been investigated, some factors are only identified during 4D-HyCoSy, thus currently no studies on preventing intravasation. However, several preprocedural features can be collected in advance, which may be valuable in predicting intravasation. Objective The purpose of this study is to establish a nomogram incorporating the preprocedural features to predict the risk of intravasation before TVS 4D-HyCoSy. Methods The data of 276 infertile women with patent fallopian tubes were analyzed retrospectively. They were assigned to the study group (n = 62) and the control group (n = 214) according to the development of intravasation. The preprocedural characteristics were collected to investigate the predictors independently associated with intravasation, which were then served as the construction of a nomogram. The performance of the nomogram was verified internally. Results History of uterine curettage ( OR = 2.341, P = 0.009), endometrial thickness ( OR = 0.587, P < 0.001), and examination schedule ( OR = 0.790, P = 0.024) were found to be the independent influencing factors associated with intravasation. The established nomogram incorporating these preprocedural features was useful for predicting the risk of intravasation prior to 4D-HyCoSy. It yielded net benefits when the predicted probability was less than 50%. Conclusion The nomogram incorporating the preprocedural characteristics achieved a net benefit for clinical decision-making when the estimated risk was less than 50%. It is recommended to change the examination schedule for patients with an estimated risk greater than 50% and perform 4D-HyCoSy when the risk is less than 50%.

Contrast Agent Reflux in Transvaginal 4-D Hysterosalpingo-Contrast Sonography

“…Endometrium is affected by estrogen and progesterone, and the thickness is different in different menstrual periods. 33 The large time span and individual differences led to great differences in intimal thickness. 34 If the endometrium is thin, the epithelial cells, interstitial structure, and neovascularization of the functional layer have not been completely repaired, or the basal layer is damaged, it is easy to cause the contrast medium to flow back into the myometrium or parauterine venous plexus, therefore affecting the observation of normal angiographic images.…”

“…The endometrium is the innermost layer of the uterine wall, which is divided into the following 3 layers: the dense layer, the spongy layer, and the basal layer, in which the dense layer and spongy layer are covered above the basal layer, also known as the functional layer. Endometrium is affected by estrogen and progesterone, and the thickness is different in different menstrual periods 33 . The large time span and individual differences led to great differences in intimal thickness 34 .…”