Operator’s Influence on Contrast Agent Intravasation During Hysterosalpingo-Contrast Sonography: Explanation Based on a Physics Model

Abstract

Objective To analyze the risk factors of the operators on contrast agent intravasation during hysterosalpingo-contrast sonography (HyCoSy). Methods We retrospectively collected 399 infertile women who underwent HyCoSy by the same sonographer. These patients were divided into two groups according to the way how the assistants connected the syringe to the uterus radiography catheter to inject the contrast agent. We analyzed whether the use of different contrast bolus injection methods had any influence on the incidence of intravasation during HyCoSy. Results There was no significant difference between the two groups with different cross-sectional areas of the syringe outflow tract in the risk variables for intravasation, but the intravasation rates of the two groups were different, 26.4% in group A and 17.1% in group B, P <0.05. The primary manifestation was that when both fallopian tubes were unobstructed, the intravasation rate of group B with smaller cross-sectional area of the outflow tract of the syringe was lower, and the difference was statistically significant. The inferences drawn from our physics model were also in line with the clinical results. Conclusion The influence of different operators on the contrast agent intravasation rate of HyCoSy cannot be ignored. The assistants of HyCoSy examination should inject the contrast agent slowly and steady, and a needle can be used as a flow restrictor to control the flow into the uterine cavity per unit time, slow down the rising speed of intrauterine pressure, and avoid the accumulation of contrast agent in the uterine cavity, so as to reduce the intravasation caused by operator factors.

Contrast Agent Reflux in Transvaginal 4-D Hysterosalpingo-Contrast Sonography

“…Although TVS 4-D HyCoSy can observe the flow path of contrast medium many times through frame-by-frame playback, to a certain extent, it helps distinguish between countercurrent and normal fallopian tube images, but if countercurrent of contrast agent reflux is earlier than fallopian tube development, it will make it difficult to distinguish fallopian tube from branched countercurrent images. 21,22 The results of this study show that the incidence of contrast agent reflux in patients undergoing TV 4-D HyCoSy is 38.94%. In addition, the history of uterine cavity operation, adenomyosis of uterus, examination on less than 5 days after menstruation, endometrial thickness, and endometrial polyps are all correlated with contrast agent reflux in patients undergoing TV 4-D HyCoSy.…”

“…The countercurrent phenomenon of contrast agent reflux is more common; when the countercurrent appears near the uterine angle, it is easy to overlap with the interstitial image of fallopian tube, so it is difficult to judge the course and patency of abnormal fallopian tube and interfere with the operator's analysis and judgment of the image. Although TVS 4-D HyCoSy can observe the flow path of contrast medium many times through frame-by-frame playback, to a certain extent, it helps distinguish between countercurrent and normal fallopian tube images, but if countercurrent of contrast agent reflux is earlier than fallopian tube development, it will make it difficult to distinguish fallopian tube from branched countercurrent images 21,22 . The results of this study show that the incidence of contrast agent reflux in patients undergoing TV 4-D HyCoSy is 38.94%.…”