Journal of Human Reproductive Sciences

LETTER TO EDITOR
Year
: 2014  |  Volume : 7  |  Issue : 2  |  Page : 154--155

The role of other imaging modalities in evaluating the tubal patency


Mahyar Mohammadifard1, Amin Saburi2,  
1 Department of Radiology, Imam Reza University Hospital, Birjand University of Medical Sciences, Birjand, Iran
2 Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

Correspondence Address:
Amin Saburi
Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Mollasadra Street, Vanak Square, Tehran
Iran




How to cite this article:
Mohammadifard M, Saburi A. The role of other imaging modalities in evaluating the tubal patency.J Hum Reprod Sci 2014;7:154-155


How to cite this URL:
Mohammadifard M, Saburi A. The role of other imaging modalities in evaluating the tubal patency. J Hum Reprod Sci [serial online] 2014 [cited 2020 Jul 8 ];7:154-155
Available from: http://www.jhrsonline.org/text.asp?2014/7/2/154/138877


Full Text

Sir,

I anxiously read the recently published an article in your journal entitled "Imaging techniques for assessment of tubal status" and I found it as a very well-structured article, which reviewed the evidence about the imaging modalities for evaluation of the tubal patency. [1] They finally focused and confirmed on the hysterosalpingo-contrast-sonography (HyCoSy) as a new and potentially useful and reliable imaging in these patients. Although they attempted to review all applied imaging technique, they missed some valuable and practical, which we would like to talk about them in this letter.

A newly considered imaging which every day is declared its value in assessing the pelvic organs especially uterus is magnetic resonance imaging (MRI). MRI-hysterosalpingography (MR-HSG) in addition to conventional MRI (with or without contrast) is effectively used in diagnosing the tubal and uterus cause of infertilities. MR-HSG was firstly used for a 32-year-old woman with a history of iodine-induced hypothyroidism, which conventional HSG was contraindicated for her. [2] On that time, MR-HSG was recommended for patients with contraindication for conventional HSG. The method of MR-HSG was simply and briefly described in the following sentence derived from Ma et al. study; "A balloon catheter was placed into the uterine cavity, and then flash 3D coronal scanning by MRI was performed with the uterine injection of a diluted mixture of gadolinium-based contrast (1:100), and data were reconstructed after digital subtraction scan." [3]

There are many benefits in MR-HSG, which stated in the previous reports; (1) Nonionizing radiation is used in scanning, it is so important when consider that the target population of this workup is in fertility age, (2) it is not operator dependent versus sonography, (3) evaluating the other causes of infertility and assessing the adjacent organs, (4) selective tubal catheterization is possible during the procedure, (5) excellent resolution and multiplanar imaging, (6) evaluating distal tubal pathology and possible peritubal adhesions. [4],[5]

However, there is some limitation for this modality; (1) An experienced reader and radiologist is needed for interpreting the pictures, (2) there are some contraindications for MR-HSG including general MRI contraindication such as hepatic and renal insufficiency, intolerance to gadolinium-based contrast, severe claustrophobia, and metal device in body, e.g. cardiac pacemakers, cochlear implants. Furthermore, MR-HSG is an expensive and time lasting procedure which is the other limitations. (3) Dislocating the catheter due to unavoidable motion and higher failure rate, (4) felling discomfort during the contrast injection up to 21%. [6]

Thirty minutes is the maximum time, which take by MR-HSG that is acceptable for nonemergency patients such as infertile women. [7] Furthermore, MR-HSG can be hybrid with conventional radiography for more accurate diagnosis of the anatomical defects. [8]

On the other hand, other multi-sectional imaging which can provide more anatomic information is virtual HSG with multidetector computed tomography (CT) technique. Due to high dose of radiation, this modality is not preferred for simple and noncomplicated cases but sometimes "virtual HSG with multidetector CT may provide a diagnostic advantage in complex cases." [9]

Finally, MR-HSG or even multidetector CT scanning can be helpful in infertile patients with normal HyCoSy doubtful for tubal and peritubal lesions.

References

1Panchal S, Nagori C. Imaging techniques for assessment of tubal status. J Hum Reprod Sci 2014;7:2-12.
2Furuhashi M, Miyabe Y, Katsumata Y, Oda H, Imai N. Magnetic resonance imaging with gadolinium-diethylenetriamine pentaacetic acid is useful in assessment of tubal patency in a patient with iodine-induced hypothyroidism. Magn Reson Imaging 1998;16:339-41.
3Ma L, Wu G, Wang Y, Zhang Y, Wang J, Li L, et al. Fallopian tubal patency diagnosed by magnetic resonance hysterosalpingography. J Reprod Med 2012;57:435-40.
4Imaoka I, Wada A, Matsuo M, Yoshida M, Kitagaki H, Sugimura K. MR imaging of disorders associated with female infertility: Use in diagnosis, treatment, and management. Radiographics 2003;23:1401-21.
5Ayida G, Chamberlain P, Barlow D, Koninckx P, Golding S, Kennedy S. Is routine diagnostic laparoscopy for infertility still justified? A pilot study assessing the use of hysterosalpingo-contrast sonography and magnetic resonance imaging. Hum Reprod 1997;12:1436-9.
6Winter L, Glücker T, Steimann S, Fröhlich JM, Steinbrich W, De Geyter C, et al. Feasibility of dynamic MR-hysterosalpingography for the diagnostic work-up of infertile women. Acta Radiol 2010;51:693-701.
7De Felice C, Rech F, Marini A, Stagnitti A, Valente F, Cipolla V, et al. Magnetic resonance hysterosalpingography in the evaluation of tubal patency in infertile women: An observational study. Clin Exp Obstet Gynecol 2012;39:83-8.
8Freeman-Walsh CB, Fahrig R, Ganguly A, Rieke V, Daniel BL. A hybrid radiography/MRI system for combining hysterosalpingography and MRI in infertility patients: Initial experience. AJR Am J Roentgenol 2008;190:W157-60.
9Carrascosa PM, Capuñay C, Vallejos J, Martín López EB, Baronio M, Carrascosa JM. Virtual hysterosalpingography: A new multidetector CT technique for evaluating the female reproductive system. Radiographics 2010;30:643-61.