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Magnetic resonance hysterosalpingography in diagnostic work-up of female infertility – comparison with conventional hysterosalpingography: a randomised study

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Abstract

Objective

To compare diagnostic accuracy of MR-hysterosalpingography (MR-HSG) and conventional hysterosalpingography (X-HSG) in the evaluation of female infertility.

Methods

Forty women received prospectively both X-HSG, the gold standard technique, and MR-HSG on the same day but the order in which they were conducted was randomised. A 1.5 Tesla MRI was performed with classical sequences for pelvic analysis and an additional 3D T1-weighted sequence with intra-uterine injection of gadolinium. Two radiologists independently interpreted X-HSG and MR-HSG according to randomisation, blinded to the other results. They both then performed a second interpretation of MR-HSG blinded to the first reading with a minimum time delay of 1 week. Diagnostic performance of MR-HSG for analysis of tubal and intracavity abnormalities was evaluated by calculating sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV).

Results

Twenty-six patients were included. Diagnostic performance of MR-HSG was: Se: 91.7% (95% CI 61.5–99.8); Sp: 92.9% (95% CI 66.1–99.8) ; PPV: 91.7% (95% CI 61.5–99.8); NPV: 92.9% (95% CI 66.1–99.8). Pain analysis showed a significant statistical difference between the two procedures: average VAS for X-HSG was 4.43 (95% CI 3.50–5.36) versus 3.46 (95% CI 2.62–4.31) for MR-HSG, p=0,01. Intra- and inter-rater agreements for detection of tubal or intracavity abnormalities were 0.92 (95% CI 0.78–1.00) and 0.76 (95% CI 0.52–1.00).

Conclusion

MR-HSG is a well-tolerated technique demonstrating high accuracy in investigating tubal patency and intra-uterine abnormalities for diagnostic work-up of female infertility.

Key Points

• MR-hysterosalpingography is an innovative technique.

• Hysterosalpingography can be used to investigate tubal patency and intracavity abnormalities.

• Hysterosalpingography is a potential ‘one-stop-shop’ imaging technique for a single comprehensive examination of female infertility.

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Abbreviations

CI:

Confidence interval

FOV:

Field of view

hCG:

Human chorionic gonadotropin

ICC:

Intraclass correlation coefficient

K:

Kappa coefficient

MRI:

Magnetic resonance imaging

MR-HSG:

Magnetic resonance hysterosalpingography

NPV:

Negative predictive value

PACS:

Picture archiving system

PPV:

Positive predictive value

Se:

Sensitivity

Sp:

Specificity

SPIR:

Spectral Presaturation with Inversion Recovery

T1W:

T1-weighted

T2W:

T2-weighted

TE:

Echo time

TR:

Repetition time

TSE:

Turbo spin echo

VAS:

Visual analogue scale

WHO:

World Health Organization

X-HSG:

Conventional hysterosalpingography

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Funding

The authors state that this work has not received any funding.

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Authors

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Correspondence to Manuelle Volondat.

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Guarantor

The scientific guarantor of this publication is Dr Madleen Chassang.

Conflict of interest

The authors of this article declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Dr Eric Fontas kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• randomised controlled trial

• performed at one institution

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Volondat, M., Fontas, E., Delotte, J. et al. Magnetic resonance hysterosalpingography in diagnostic work-up of female infertility – comparison with conventional hysterosalpingography: a randomised study. Eur Radiol 29, 501–508 (2019). https://doi.org/10.1007/s00330-018-5572-2

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  • DOI: https://doi.org/10.1007/s00330-018-5572-2

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