ObjectivesTo evaluate the spectrum of diagnostic findings in hysterosalpingography (HSG) examinations performed at our institution between 2006–2010 and their prognostic significance for treatment decisions and fertility outcomes.MethodsPatients were filtered from our PACS. Pathological HSG studies were re-evaluated. Indications for referral, technical success and diagnostic findings were analysed. Pathological findings were correlated with further diagnostic workups, treatments and fertility outcomes.ResultsOf 411 HSG examinations, 226 (55 %) were normal, 94 (23 %) showed minor abnormalities and 5 (1.2 %) were not diagnostic. Eighty-six (21 %) examinations were pathological. Twenty-nine patients underwent subsequent laparoscopy, during which proximal tubal occlusion diagnosed at HSG was ruled out in 9/23 cases. Follow-up information was unavailable for 20 patients. Nineteen of 66 patients with follow-ups after pathological HSG had at least one subsequent successful pregnancy. Forty-one patients had no further treatment and no pregnancies.ConclusionsThe detection rate for pathologies at HSG was low (21 %). There was a high false-positive rate (39 %) for proximal tubal occlusion, most likely because of spasms, demonstrating the importance of delayed imaging after injection of antiperistaltic agents. HSG remains a valuable diagnostic tool. Our results, however, indicate that this technique should be more selectively indicated.Main Messages• Good acceptance of HSG by the patients. No complications with antibiotic prophylaxis.• Low detection rate (21 % pathological exams) for pathologies in our study.• High false-positive rate for proximal tubal occlusion.• This demonstrates the importance of waiting longer after injection of buscopan.• High pregnancy rate in pathological cases: Indication too broad or even a therapeutic effect of HSG?

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ObjectiveThe aim of this study was to evaluate whether the distribution pattern of early ischemic changes in the initial MRI allows a practical method for estimating leptomeningeal collateralization in acute ischemic stroke (AIS).MethodsSeventy-four patients with AIS underwent MRI followed by conventional angiogram and mechanical thrombectomy. Diffusion restriction in Diffusion weighted imaging (DWI) and correlated T2-hyperintensity of the infarct were retrospectively analyzed and subdivided in accordance with Alberta Stroke Program Early CT score (ASPECTS). Patients were angiographically graded in collateralization groups according to the method of Higashida, and dichotomized in 2 groups: 29 subjects with collateralization grade 3 or 4 (well-collateralized group) and 45 subjects with grade 1 or 2 (poorly-collateralized group). Individual ASPECTS areas were compared among the groups.ResultsMeans for overall DWI-ASPECTS were 6.34 vs. 4.51 (well vs. poorly collateralized groups respectively), and for T2-ASPECTS 9.34 vs 8.96. A significant difference between groups was found for DWI-ASPECTS (p<0.001), but not for T2-ASPECTS (p = 0.088). Regarding the individual areas, only insula, M1-M4 and M6 showed significantly fewer infarctions in the well-collateralized group (p-values <0.001 to 0.015). 89% of patients in the well-collateralized group showed 0–2 infarctions in these six areas (44.8% with 0 infarctions), while 59.9% patients of the poor-collateralized group showed 3–6 infarctions.ConclusionPatients with poor leptomeningeal collateralization show more infarcts on the initial MRI, particularly in the ASPECTS areas M1 to M4, M6 and insula. Therefore DWI abnormalities in these areas may be a surrogate marker for poor leptomeningeal collaterals and may be useful for estimation of the collateral status in routine clinical evaluation.