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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The scientific guarantor of this publication is Dr Madleen Chassang.
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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.
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Dr Eric Fontas kindly provided statistical advice for this manuscript.
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Written informed consent was obtained from all subjects (patients) in this study.
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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