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

Abstract

Transvaginal three-dimensional saline SHSG provides good visualization of the uterine cavity and myometrial walls in three orthogonal planes. However, it does not diagnose tubal occlusion or depict architecture of the fallopian tube as accurately as X-ray HSG. Although we were able to visualize the distal fallopian tube and fimbria with real-time imaging, we were not able to satisfactorily image the proximal tube with three-dimensional power Doppler. This technique may be reserved as an initial screening test to evaluate the uterine cavity and test patency. Patients at high risk for tubal disease by history or with suspected tubal occlusion on three-dimensional saline SHSG should be evaluated by either X-ray HSG or laparoscopy with chromopertubation. Further improvements of three-dimensional technology and contrast materials will, it is hoped, make this method comparable to X-ray HSG.

Two-dimensional HyCoSy with contrast tuned imaging technology and a second-generation contrast media for the assessment of tubal patency in an infertility program

“…This latter solution has the advantages of being safe and inexpensive (8) and can be performed in the same center and often at the time of the first consultation. Some investigators (9)(10)(11)(12) have demonstrated the limitations of conventional two-dimensional HyCoSy (2D-HyCoSy), which are mainly due to the fact that the fallopian tubes are rarely visualized completely because of their anatomical tortuosity. In most cases, only the proximal part is visualized.…”

The Clinical Value of 3‐Dimensional Saline Infusion Sonography in Addition to 2‐Dimensional Saline Infusion Sonography in Women With Abnormal Uterine Bleeding

“…17 Increasing experience with 3D sonography in combination with many favorable reports on SIS resulted in the introduction of 3D-SIS. [18][19][20][21][22][23] Although some studies concluded that more research is necessary for a final decision about the clinical relevance of 3D-SIS, 18,23 others reported excellent specificity and positive predictive values for 3D-SIS. [19][20][21] Therefore, 3D-SIS may be of clinical relevance because its use may increase the positive predictive value of SIS and may prevent women with a normal uterine cavity from undergoing diagnostic hysteroscopy.…”

Tubal assessment and disease

“…Thus, Sankpal et al compared 3D power Doppler SHSG to conventional HSG in 15 infertility patients. 3D SHSG had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of detecting tubal occlusion of 75, 86, 42 and 95%, respectively [26]. Other investigators have also shown that 3D power Doppler with offline surface-rendering image manipulation overcomes the limitations of conventional 2D SHSG.…”