Virtual Hysterosalpingography: A New Multidetector CT Technique for Evaluating the Female Reproductive System

Abstract

Recent advances in reproductive medicine have generated a demand for more accurate imaging methods for identifying the specific cause of female infertility and other gynecologic disorders. Virtual hysterosalpingography is an emerging modality in which aspects of the established technique of hysterosalpingography are combined with the cutting-edge technology of multidetector computed tomography (CT) to allow a comprehensive and highly accurate evaluation of both the female reproductive system and the pelvic anatomy generally. Unlike ultrasonography (US) and magnetic resonance (MR) imaging, multidetector CT is capable of depicting both the external and internal surfaces of the uterus, fallopian tubes, and other pelvic organs, providing high-resolution data that are suitable for two- and three-dimensional reconstructions and virtual endoscopic views. Thus, virtual hysterosalpingography may prove to be superior to other noninvasive modalities for evaluating tubal patency. Moreover, in comparison with conventional hysterosalpingography, which may involve cervical clamping, virtual hysterosalpingography is painless. Because of the health risks associated with ionizing radiation, the use of another modality (eg, MR imaging, US) may be preferred if the presence of a focal uterine lesion is strongly suspected. However, virtual hysterosalpingography with multidetector CT may provide a diagnostic advantage in complex cases.

Utility of 128-multislice CT virtual HSG in assessment of female infertility

“…Similarly other researchers [5,6] had found better diagnostic value of MDCT-HSG because its ability to define contour, outer wall and myometrium of the uterus making MDCT-VHSG more accurate in differentiating between a septate and bicornuate uterus and the virtual of MDCT-VHSG endoscopy showed uterine filling defects such as polyps and synechiae compared to the X-ray HSG where the dense contrast media may obscure such delicate lesions [7]. Similarly Carrascosa et al [4] were able to correctly diagnose submucosal myomas, endometrial polyps, and uterine anomalies by using MCDT virtual hysteroscopy.…”

Virtual Hysterosalpingography: Its Place in the Workup of Infertile Women

“…Authors have listed a radiation dose level of 2.6 mSv for a virtual HSG which is permissible as per ACR guidelines [6][7][8]. However, in our patients, the dose is much higher than this value and we would not recommend it based on this fact alone.…”

“…Drawbacks include its exposure to radiation and patient discomfort. In the past years, reports have been put to print on the role of virtual HSG [6][7][8]. Carrascosa et al have fervently promoted virtual HSG as one that provides 'comprehensive and highly accurate evaluation of both the female reproductive system and pelvic anatomy.'…”

Virtual hysterosalpingography in the diagnosis of bicornuate versus septate uterus

“…Although the very small amount of ionizing radiation in VHSG becomes a potential disadvantage, we firmly believe that VHSG not only offers the diagnostic ability to focus on the uterine malformation by clearly identifying the outer fundal contour of the uterus, but it is also helpful in the evaluation of the fallopian tubes and their patency (8). In addition, because the technique does not require a tenaculum for tractioning the cervix or for the patient to change positions during the study, the procedure is extremely well tolerated.…”

“…The 64-row multislice CT scanner generated virtual studies with excellent resolution and image quality. Virtual studies require volumetric CT data acquisition and a posterior reprocessing technique using different modalities, such as 3D volume rendering and virtual endoscopic images, giving an integral evaluation of the selected system, in this case the uterus and fallopian tubes (8).…”