RSNA 2013 

Abstract Archives of the RSNA, 2013


SSJ12-01

MR Hysterosalpingography, a Radiation Free Alternative to Laparoscopy in Female Infertility: Our Experience

Scientific Formal (Paper) Presentations

Presented on December 3, 2013
Presented as part of SSJ12: Genitourinary (Diagnosis of Benign Gynecologic Processes, Tubal Occlusion)

Participants

Natalia Teresita Posadas MEd, Presenter: Nothing to Disclose
Andres Kohan MD, Abstract Co-Author: Research support , Koninklijke Philips Electronics NV
Mariana Cecilia Kucharczyk MD, Abstract Co-Author: Nothing to Disclose
Maria Noelia Napoli MD, Abstract Co-Author: Nothing to Disclose
Nora Angelica Fuentes, Abstract Co-Author: Nothing to Disclose
Ricardo D. Garcia-Monaco MD, PhD, Abstract Co-Author: Nothing to Disclose
Santiago Gil, Abstract Co-Author: Nothing to Disclose
Carolina Rosa Chacon MD, Abstract Co-Author: Nothing to Disclose

PURPOSE

Female infertility workup usually involves ultrasound and hysterosalpingography (HSG) to assess for tubal patency, myomas and endometriosis. However, none evaluates the female pelvis as thoroughly and in a single exam as laparoscopy. MRHSG has been described as a possible one-stop-shop exam with encouraging results. Our purpose is to show our experience in MRHSG

METHOD AND MATERIALS

37 patients referred to radiology for pelvic MRI were included in this research. MRHSG was performed in a 1.5T MR using a hysterosonogram catheter and an automated pump during routine pelvic MRI. Following a non-contrast exam, images were acquired before, during and after intrauterine injection of diluted Gd. Three days later patients were evaluated for complications. Independent assessment of pelvic pathology and tubal patency was done by two experienced radiologists (8y, 11y). Upon discrepancy, agreement was reached by consensus. Descriptive and analytical statistical analyses were performed, and frequencies were calculated. Mann-Whitney U test for independent samples was performed to detect significant differences.

RESULTS

Mean age was 35±4. Referral indications were: 38% endometriosis, 32% myomas, 27% infertility and 3% other. Mean study duration and injected volume were 50±25 min and 26±16cc. Up to 72hs after the procedure, 8% of clinically irrelevant adverse events were recorded. Mean exam discomfort assessed by a 0 to 100 visual scale was 36±22. MRHSG was successfully performed in 84% of patients showing tubal patency in 73% and occlusion in 11%. Up to 27% of the patients were newly diagnosed with fertility altering conditions. When comparing normal to enlarged uterus, mean injected volume was significantly (P<0.05) lower in the first (21cc vs. 34cc), while discomfort showed a tendency (P=0.06) to be lower (42 vs. 27) in the latter. 81% of overall patients and 73% of patients with a previous conventional HSG were willing to repeat the procedure in the future

CONCLUSION

MRHSG showed high acceptability and success rate for tubal patency assessment while simultaneously evaluating and diagnosing relevant diseases in infertility, thus becoming a potential one-stop-shop solution for female infertility

CLINICAL RELEVANCE/APPLICATION

Female infertility is usually evaluated with many separate imaging studies (US, HSG, MR) or, even worse, laparoscopy. MRHSG could be a one-stop-shop exam for this patient population.

Cite This Abstract

Posadas, N, Kohan, A, Kucharczyk, M, Napoli, M, Fuentes, N, Garcia-Monaco, R, Gil, S, Chacon, C, MR Hysterosalpingography, a Radiation Free Alternative to Laparoscopy in Female Infertility: Our Experience.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13010697.html