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PubMed1986

Radiation dose reduction during hysterosalpingography: an application of scanning-beam digital radiography.

Hysterosalpingography was performed in 31 patients by means of a low-dose scanning-beam digital radiographic system. The technique permits adequate evaluation of gynecologic abnormalities while allowing significant reduction in radiation: 2.4-mR (6.1 X 10(-7) C/kg) exposure to the skin and 0.7-mrad (7 X 10(-6) Gy) mean dose to the ovaries per image obtained. Sixteen patients demonstrated readily recognizable and documented abnormalities, corroborated by laparoscopy, laparotomy, or other supportive evidence.

Adolescent↗
PubMed1990

Device for hysterosalpingography and fallopian tube catheterization.

A device was developed for hysterosalpingography and fallopian tube recanalization. It differs from the previously used vacuum-cup device in that the central shaft slides and has an acorn-shaped tip. Optimal results were obtained in all 14 women (100%) who underwent catheterization with the new device; optimal results were achieved in only five of eight women (62%) who underwent catheterization with the fixed-shaft device during the same time period.

Catheterization↗
PubMed1991

Diagnostic quality and complications of hysterosalpingography: oil- versus water-soluble contrast media--a randomized prospective study.

In a prospective randomized study of 417 patients, side effects and complications of contrast media and the diagnostic quality of images obtained after hysterosalpingography (HSG) were evaluated after use of diatrizoate meglumine (104 patients), ioxaglate (105 patients), iohexol (105 patients), or ethiodized poppy-seed oil (103 patients). The authors detected no differences among these groups in the prevalence of pain during HSG. The prevalence of lower abdominal pain and vaginal bleeding after HSG was significantly lower in the group that received ethiodized poppy-seed oil than in the three other groups. The prevalence of pelvic infection or inflammation was significantly lower with ethiodized poppy-seed oil than with water-soluble media. All contrast media provided acceptable diagnostic image quality with regard to fallopian tubes, peritoneal spill, and intraperitoneal distribution. Visualization of the uterine cavity and ampullary rugae was significantly better with water-soluble media than with ethiodized poppy-seed oil, which was associated with a high conception rate and which the authors consider preferable for HSG.

Contrast Media↗
PubMed1991

Therapeutic effect of hysterosalpingography: oil- versus water-soluble contrast media--a randomized prospective study.

In a prospective randomized study, the number of pregnancies after hysterosalpingography (HSG) was estimated in 398 patients who had been infertile for longer than 1 year. Iohexol was used in 101 patients, ioxaglate in 102 patients, diatrizoate meglumine in 97 patients, and ethiodized poppy-seed oil in 98 patients. Ten months after HSG, the patient, referring physician, and/or hospital department was consulted for information about pregnancies. Questionnaires were obtained from the patients who became pregnant during the waiting period of 3 months. No differences in demographic parameters, infertility status, or diagnosis made with HSG were detected among the four contrast media groups. Significantly more patients became pregnant after HSG in the ethiodized poppy-seed oil group than in the three water-soluble contrast media groups (P less than .01). When only intrauterine pregnancies resulting in full-term births were considered, significant differences in pregnancy rates between the oil-soluble and the water-soluble contrast media groups became more obvious. In the group that received ethiodized poppy-seed oil, almost one-third of the infertile women had normal pregnancies and childbirths after HSG.

Contrast Media↗
PubMed1992

Diagnosis of uterine anomalies: relative accuracy of MR imaging, endovaginal sonography, and hysterosalpingography.

The purpose of this study was to compare the relative accuracy of magnetic resonance (MR) imaging (n = 26), endovaginal sonography (EVS) (n = 14), and hysterosalpingography (HSG) (n = 20) in the classification of müllerian duct anomalies in 26 patients. There were 24 cases of surgically proved anomaly, and two patients had normal uteri (one with a vaginal septum). MR imaging allowed diagnosis of 24 of 24 cases (accuracy, 100%), and EVS was correct in 11 of 12 cases (accuracy, 92%). HSG was correct in only four cases. In the diagnosis of septate uterus, MR imaging demonstrated a sensitivity and specificity of 100% and EVS demonstrated a sensitivity of 100% and a specificity of 80%. Both MR imaging and EVS demonstrated a sensitivity and specificity of 100% in distinguishing those anomalies that did not require surgery. The high accuracy of MR imaging and EVS permit noninvasive differentiation of uterine anomalies and can spare women diagnostic laparoscopy, promoting cost-effective diagnosis.

Congenital Abnormalities↗
PubMed1994

Use of iotrolan versus ethiodized poppy-seed oil in hysterosalpingography.

PURPOSE: To compare use of the water-soluble, nonionic isosmolar dimer iotrolan with that of ethiodized poppy-seed oil in hysterosalpingography with regard to side effects, diagnostic quality, and postexamination conception rates. MATERIALS AND METHODS: A prospective randomized design was used in a study of 245 patients. Questionnaires and patient records were used to acquire information. All examinations and ratings of diagnostic quality were performed by the same three investigators. Statistical calculations were performed with the chi 2 test, including the Mantel-Haenszel variant, and the Kruskal-Wallis test. RESULTS: No substantial differences between the contrast media could be detected concerning pain during the procedure, delayed pain, or postexamination bleeding. Visualization of the uterine cavity and ampullary rugae was markedly better with use of iotrolan. The postexamination conception rate was higher with use of ethiodized poppy-seed oil (24.0%) but was not significantly different statistically (P = .44) from that seen after use of iotrolan (19.8%). CONCLUSION: The authors believe the use of iotrolan is preferable to that of ethiodized poppy-seed oil.

Abdominal Pain↗
PubMed1996

Distal fallopian tube occlusion: false diagnosis with hysterosalpingography in cases of tubal diverticula.

PURPOSE: To evaluate the accuracy of hysterosalpingography (HSG) in the diagnosis of distal fallopian tube occlusion in infertile patients who were candidates for laparoscopic surgery. MATERIALS AND METHODS: A retrospective review of charts was performed for 25 patients who were scheduled to undergo laparoscopic surgery. A preoperative diagnosis was made at HSG of bilateral (or unilateral in case of previous contralateral salpingectomy) distal tube occlusion. RESULTS: At laparoscopy, in three patients (12%) who were scheduled for salpingostomy, the diagnosis of distal tube occlusion made at HSG was incorrectly positive; in the three patients, a single tubal diverticulum was present in the distal ampulla in otherwise normal, patent tubes. CONCLUSION: Bilateral tubal diverticula appear to be often misdiagnosed at HSG as distal tube occlusion.

Adult↗
PubMed2000

Potential therapeutic effects of contrast materials in hysterosalpingography: a prospective randomized clinical trial. Kaiser Permanente Infertility Work Group.

PURPOSE: To evaluate the influence of the contrast material used in hysterosalpingography (HSG) on subsequent reproductive success, independent of other therapeutic interventions. MATERIALS AND METHODS: In a prospective, multisite, randomized trial, 666 women who had been infertile for more than 1 year and were scheduled to undergo HSG as part of their evaluation were assigned to one of three groups: those receiving water-soluble contrast material (WSCM) (n = 260), those receiving oil-soluble contrast material (OSCM) (n = 273), and those receiving both OSCM and WSCM (n = 133). Possible causes of infertility and therapeutic interventions were abstracted from the medical records. Data on conception within 1 year and the outcome of conception were ascertained from multiple sources. RESULTS: Of 666 women, 204 (30.6%) had at least one pregnancy, and 136 (20.4%) had live births. The rates of live births were 20.4% (54 of 260) after HSG with WSCM, 19.4% (53 of 273) after HSG with OSCM, and 21.8% (29 of 133) after HSG with both WSCM and OSCM. Differences in reproductive outcome among contrast material groups were not statistically significant ((chi2)8 = 6.08, P = .64). Whatever the cause of infertility, the use of different contrast materials led to no significant differences in the rates of live births. CONCLUSION: There is no evidence to suggest that the choice of contrast material affects the rate of term pregnancy.

Adult↗
PubMedDate not supplied

Hysterosalpingography: a reemerging study.

Hysterosalpingography (HSG) has become a commonly performed examination due to recent advances and improvements in, as well as the increasing popularity of, reproductive medicine. HSG plays an important role in the evaluation of abnormalities related to the uterus and fallopian tubes. Uterine abnormalities that can be detected at HSG include congenital anomalies, polyps, leiomyomas, surgical changes, synechiae, and adenomyosis. Tubal abnormalities that can be detected include tubal occlusion, salpingitis isthmica nodosum, polyps, hydrosalpinx, and peritubal adhesions. Some complications can occur with HSG-most notably, bleeding and infection-and awareness of the possible complications of HSG is essential. Nevertheless, HSG remains a valuable tool in the evaluation of the uterus and fallopian tubes. Radiologists should become familiar with HSG technique and the interpretation of HSG images.

Fallopian Tube Diseases↗
PubMed2006

Opioid analgesia for hysterosalpingography: controlled double-blind prospective trial with remifentanil and placebo.

BACKGROUND/AIMS: A hysterosalpingogram is an integral part of the evaluation of infertility, however, it is often painful. METHODS: We conducted a randomized double-blinded, placebo-controlled trial of intravenous infusion of remifentanil in women undergoing hysterosalpingography (HSG). We randomly allocated 62 patients scheduled for HSG to receive either a continuous infusion of 0.25 microg.kg(-1) of remifentanil or placebo. The degree of pain was documented via 10-cm visual analog scales (VAS). Patients' discomfort, side effects and recovery times were also recorded. RESULTS: The VAS scores during HSG were 1.25 +/- 1.31 in the remifentanil group and 4.78 +/- 1.7 in the placebo group (p < 0.001). There were more patients in the remifentanil group that rated their condition as excellent (p < 0.001). The groups did not differ with regard to the incidence of side effects. The recovery times were found statistically longer in the remifentanil group (14 +/- 5 vs. 10 +/- 3 min). All the patients were discharged 30 min after the procedures without any side effects. CONCLUSION: Remifentanil infusion during HSG is superior to placebo for relief of pain with minimal opioid side effects.

Adult↗
PubMed1997

Pregnancy rate following normal versus abnormal hysterosalpingography findings: a meta-analysis.

A computerized Medline search was conducted, to assess the prognostic value of hysterosalpingography (HSG) and the probability of pregnancy after normal versus abnormal HSG findings. A total of 13 studies turned out to be eligible, reporting on 3,277 women. 15% of women with an abnormal HSG and 32% of women with a normal HSG achieved pregnancy. Sensitivities and specificities of the studies were heterogeneous. The pooled odds ratio was 3 (95% CI: 2.3-3.4). Its ROC Curve shows that, at the operating point yielding the lowest number of misclassifications, a sensitivity of 63% and a specificity of 62% is achieved. Seven studies reported unilateral and bilateral obstruction. Odds ratios were 2(95% CI: 1.5-2.6) and 19(95% CI: 7.5-46.5) respectively. So, overall, HSG has a low prognostic value, the outcome of HSG adds little to predicting the occurrence of pregnancy. However, when HSG shows bilateral obstruction, the chance of getting pregnant is only minimal.

Fallopian Tube Diseases↗
PubMed1997

A comparison of pain tolerance during X-ray hysterosalpingography and sonohysterosalpingography. Albunex Study Group.

The objective of this study was to determine patient perception of the level of discomfort during sonohysterosalpingography (sono-HSG) compared with standard X-ray hysterosalpingography (HSG). This was a prospective, operator-blinded, multicenter study using both numerical ranking and a visual analog scale to quantify discomfort. Sono-HSG utilizing Albunex was associated with a significantly lower mean intensity of pain than the instillation of X-ray contrast media. Sono-HSG is an alternative to X-ray HSG in the evaluation of the uterus and fallopian tubes and compares favorably with respect to patient discomfort.

Albumins↗
PubMedDate not supplied

Inadvertently performed hysterosalpingography during early pregnancy.

A review of 6,225 hysterosalpingographies disclosed four cases of inadvertently performed examinations during early pregnancy. These radiologic misadventures were in three cases performed because of oligomenorrhoea and in one case because of a misjudged decidual bleeding. The radiologic findings and the outcome of these pregnancies are presented. Precautions to avoid this radiographic error are discussed.

Abnormalities, Radiation-Induced↗
PubMed1980

Hysterosalpingography: an appraisal of current indications.

A prospective study was carried out on 230 consecutive hysterosalpingograms (HSGs), in which a variety of techniques was used. The primary site of investigation was tubal, uterine and cervical in 76.5, 7.8 and 15.7% of cases respectively. The highest incidence of abnormal findings was obtained in the investigation of secondary infertility, especially following tubal surgery. Twenty-five women had a laparoscopy and dye insufflation within nine months of their HSG, and fully concordant results were found in 17 cases. The disposable cervical cup method of hysterosalpingography offered a precise means of quantifying the internal cervical os diameter. The mean internal os diameter in those women referred with a past history of mid-trimester abortion was significantly greater than that of the group with secondary infertility (P less than .05). A diameter of 0.7 cm is suggested as a practical cut-off point for the radiological diagnosis of cervical incompetence.

Abortion, Habitual↗
PubMed1991

A comparison between iotrolan, a non-ionic dimer, and a hyperosmolar contrast medium, Urografin, in hysterosalpingography.

For hysterosalpingography, there were no significant differences between the non-ionic dimeric contrast medium iotrolan (300 mgI/%) and Urografin (370 mgI/%) with regard to ease of application or radiographic quality, and both agents were equally suitable. There were no significant differences between two groups of patients with regard to pain due to instrumentation, pain at the time of injection and pain up to 2 h after the procedure. There was a significant difference (p = 0.04) between the two groups with respect to delayed pain, when iotrolan was associated with a lower incidence and decreased severity of delayed pain. There were no differences in the incidence of nausea, vomiting, headache and syncope. No allergic phenomena were seen in either group.

Adult↗
PubMed1992

The role of hysterosalpingography in modern gynaecological practice.

A retrospective review of hysterosalpingography (HSG) in a major gynaecological centre was carried out. 324 patients attended (95%) for HSG out of 341 patients referred for this investigation. 189 examinations (58.3%) were abnormal. The requests and radiological findings were reviewed and the results compared with laparoscopy. HSG remains an integral part of gynaecological investigation and its value has not diminished in modern practice.

Adult↗
PubMed1994

Entrance surface and ovarian doses in hysterosalpingography.

A survey of entrance surface doses on 40 patients undergoing hysterosalpingography (HSG) has been undertaken. HSG is performed on women primarily of child-bearing age, with the dose to the gonads of these patients being of significant interest. Four lithium fluoride thermoluminescent dosimeters (TLDs) were attached to anatomical landmarks on the patient's skin to measure entrance surface doses. The results ranged from 0.5 mGy to 38.6 mGy with an average entrance surface dose of 13.3 mGy measured at the symphysis pubis. A correlation was observed between the entrance surface dose and imaging technique. Higher doses were measured when 24 x 30 cm film-screen radiography was used as opposed to fluoroscopy using 100 mm cut film for hard copy. Estimates of the organ dose to the ovaries were derived for both techniques yielding 2.8 mGy for 24 x 30 cm film-screen radiography and 1.7 mGy for 100 mm cut film.

Calibration↗