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Objetivo: Comparar la prueba del catéter cervical con la histerosalpingografía virtual (HSGV) en la evaluación del cuello uterino antes de la transferencia embrionaria. Material y métodos: Fueron evaluadas 100 pacientes con antecedentes de infertilidad. El día del examen, un ginecólogo realizó la prueba del canal cervical con un catéter de Wallace. Luego se realizó una HSGV con un tomógrafo de 256 cortes. Las imágenes fueron evaluadas por un radiólogo, y se determinaron la permeabilidad del cuello uterino, el ángulo cérvico-uterino y la presencia de patología cervical. Resultados: Se observó una buena correlación (r=0,92) en la evaluación de la permeabilidad del cuello uterino entre ambos métodos. En el 35 % de las pacientes la prueba del catéter cervical no fue exitosa, y la HSGV detectó pólipos, sinequias y trayectos sinuosos del canal cervical; mientras que en 23 pacientes el cuello uterino fue normal, pero el ángulo cérvico-uterino fue < 90°. Conclusiones: Hubo una buena correlación entre la HSGV y la prueba de catéter cervical en la evaluación de la permeabilidad del cuello uterino. La HSGV proporciona, además, información anatómica útil para identificar la causa probable del fracaso de la transferencia de embriones.

Objective: To compare cervical catheter test and virtual HSG in the evaluation of cervix before embryo transfer. Methods: We evaluated 100 patients with history of infertility. On the day of examination, a gynaecologist performed a cervical test with a Wallace catheter. Then, patients underwent Virtual HSG performed with a 256-slice CT scanner. CT images were evaluated by a radiologist, and the cervical patency, utero-cervical angle and the presence of cervical pathology were determined. Results: There was a good correlation (r=0,92) in cervical patency evaluation between both methods. Unsuccessful cervical catheter test was observed in 35% of patients. In these patients, Virtual HSG detected polyps, adhesions and sinuous cervical canal, while cervix was normal in 23 patients, but the utero-cervical angle was < 90°. Conclusions: There was a good correlation between HSG findings and the cervical catheter test in the evaluation of cervical patency. Moreover virtual HSG provides anatomic information useful to identify the probable causes of failure of embryo transfers.

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OBJECTIVE: To study the value of virtual hysterosalpingography (VHSG) in the diagnosis of bicornuate vs. septate uterus. DESIGN: Retrospective study of all cases with bicornuate or septate uterus that had VHSG during the last 3 years at our center. SETTING: Private fertility center and radiology institute with university affiliations. PATIENT(S): A total of 47 patients (from more than 1,000 studies) with bicornuate uterus (n = 15) or septate uterus (n = 32) were analyzed to determine the ability of VHSG to distinguish both entities. INTERVENTION(S): Virtual hysterosalpingography was performed in patients with bicornuate or septate uterus. MAIN OUTCOME MEASURE(S): Procedure length, discomfort, amount of radiation, and ability to outline the uterine fundus. RESULT(S): We were able to clearly distinguish bicornuate from septate uterus. In all patients who underwent septoplasty the VHSG diagnosis of septate uterus was confirmed. Virtual hysterosalpingography was well tolerated by all patients; scanning took 5 seconds per patient, and the average radiation was very low (0.9 ± 0.7 mSv). CONCLUSION(S): Virtual hysterosalpingography seems to be a valuable tool in the diagnosis of common uterine anomalies.

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With the advent of multidetector computed tomography (MDCT), a whole new spectrum of diagnostic imaging techniques and procedures appears. Virtual hysterosalpingography (VHSG) is a novel non-invasive modality for assessing the uterus and female reproductive system that combines hysterosalpingography technique with MDCT technologies. Nowadays, 64-row VHSG offers an excellent diagnostic performance, in concordance with the development of new reproductive interventions and the need of accurate diagnostic procedures. In this article, we review the VHSG technique and describe normal and pathologic findings.

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Objective. To depict typical features of virtual hysterosalpingography (VHSG) in infertile patients. Material and methods: 2500 VHSG performed using a 64-row MDCT were evaluated. Results: Cervical abnormalities visualized corresponded to parietal irregularities (21 percent); thickened folds (9 percent); polyps (11 percent); diverticula (5 percent); cervical strictures (8 percent), and synechiae (1.5 percent). At the level of uterine cavity, polyps (44 percent); submucous myomas (8 percent); intramural and subserosal fibroids (11 percent); synechiae (10 percent); malformations (10 percent); adenomyosis (4 percent), and cesarean section scar (3 percent). Unilateral hydrosalpinx (7 percent) and bilateral hydrosalpinx (2 percent). Tubal obstruction was reported in 6 percent of cases. The average radiation dose was 0.94 mSv. Eighty-four percent of the patients reported mild pain or no postoperative discomfort. Conclusions: The virtual hysterosalpingography allowed a proper assessment of the internal genital organs, providing useful diagnostic information on infertility and other gynecological disorders. It constitutes a virtually painless, low-dose radiation technique, besides being well tolerated by patients.

Objetivo. Ilustrar los hallazgos característicos de la histerosalpingografía virtual (HSG-V) en pacientes en estudio de infertilidad. Material y métodos: Se evaluaron 2500 HSG-V efectuadas con un equipo de TCMD de 64 filas. Resultados A nivel del cuello se visualizaron irregularidades parietales (21 por ciento); pliegues engrosados (9 por ciento); pólipos (11 por ciento); divertículos (5 por ciento); estrechez (8 por ciento; y sinequias (1,5 por ciento). A nivel de la cavidad: pólipos (44 por ciento); miomas submucosos (8 por ciento); intramurales y subserosos (11 por ciento); y sinequias (10 por ciento); malformaciones (10 por ciento); adenomiosis (4 por ciento); cicatriz de cesárea (3 por ciento). Hidrosalpinx unilateral (7 por ciento) y bilateral (2 por ciento); obstrucción tubaria en el 6 por ciento de los casos. La dosis de radiación promedio fue 0.94 mSv. El 84 por ciento de los pacientes refirieron disconfort leve o ausente. Conclusiones: La HSG-Virtual permitió una adecuada evaluación de los órganos genitales internos, brindando información diagnóstica útil en infertilidad y otros desórdenes ginecológicos. Es una técnica poco dolorosa, bien tolerada por las pacientes y con baja dosis de radiación.

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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.

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OBJECTIVE: To illustrate the large variety of pathologies found on 64-row computed tomographic (CT) virtual hysterosalpingography (CT-VHSG) in the evaluation of the female reproductive tract in infertile patients. MATERIAL AND METHODS: We prospectively evaluated CT datasets from 209 patients with diagnosis of infertility. CT-VHSG was performed with a 64-row CT scanner using 64 x 0.625 mm(2) collimation and 0.9 mm slice thickness. A total volume of 20 mL of an iodine contrast dilution was injected into the uterine cavity. The duration of the CT scan and the grade of patient discomfort of the procedure were documented. Images were analyzed on a workstation. The CT-VHSG exams were divided in studies with normal or pathological findings; pathologies were classified according to their locations (cervical, uterine, and fallopian tube pathology). RESULTS: No complications occurred during the procedure. The mean scan time was 3.4 +/- 0.4 s; the mean patient effective dose was 2.58 +/- 0.75 mSv. In relation to the patient's discomfort evaluation, 55.5% of the patients referred no discomfort during the procedure. Cervical pathology was found in 100/209 patients, uterine pathology in 93/209 patients, and fallopian tubes pathology in 37/209 patients. CONCLUSION: A 64-row CT-VHSG provides a reliable, non-invasive alternative diagnostic technique in the infertility workup algorithm.

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OBJECTIVE: To evaluate the potential clinical value of 64-row multislice computed tomography hysterosalpingography (MSCT-H) in the evaluation of female patients with a diagnosis of infertility and compare it with the use of standard X-ray hysterosalpingography (HSG). DESIGN: Comparative prospective study. SETTING: Outpatient Imaging Diagnostic Centre, Diagnóstico Maipú, Buenos Aires, Argentina, and a university-affiliated fertility institute (Centro de Estudios en Ginecología y Reproducción, Buenos Aires, Argentina). PATIENT(S): Twenty-two female patients with a diagnosis of infertility. INTERVENTION(S): Sixty-four-row MSCT-H and conventional X-ray HSG. MAIN OUTCOME MEASURE(S): Diagnostic accuracy of MSCT-H for the evaluation of cervical, uterine, and tubal pathology. RESULT(S): We found that 64-row MSCT-H was useful in identifying female reproductive tract abnormalities, showing in the per patient analysis a sensitivity of 100% and a specificity of 85.71%. This new procedure can be performed without a tenaculum, making it well tolerated. Clinical complications did not occur in any of the patients participating in the study. CONCLUSION(S): Sixty-four-row MSCT-H is a valuable alternative diagnostic technique in the infertility workup algorithm for the evaluation of the female reproductive tract.

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OBJECTIVE: To compare the efficacy of multidetector CT virtual hysterosalpingography (MDCT-VH) with conventional X-ray hysterosalpingography (HSG) in the evaluation of patients with diagnosis of infertility. METHODS: Sixty patients with diagnosis of infertility scheduled to perform a HSG, were evaluated with 16-row (n=50) and 64-row (n=10) MDCT-VH. In 35 patients the examination was performed without a tenaculum. The HSGs were carried out using standard technique. The HSG and MDCT-VH findings were compared. The duration for both examinations and patient discomfort were documented. The sensitivity and specificity of MDCT-VH for the detection of uterine pathology and tubal obstruction were calculated using the exact binomial method. Agreement between the two methods was assessed by the Cohen's kappa method (k). RESULTS: The mean duration for MDCT-VH (16 and 64-rows) was 5+/-3 min, whereas for HSG was 28+/-3. The MDCT-VH without a tenaculum was the procedure with less patient discomfort. Sensitivity, specificity and inter-method agreement for the detection of uterine pathology were 100%, 92% and k=0.92 for 16-row MDCT-VH and 100%, 100% and k=1 for 64-row MDCT-VH, respectively. Sensitivity and specificity for detection of tubal obstruction were 80% and 80% for 16-row MDCT-VH and 100% and 100% for 64-row MDCT-VH, respectively; inter-method agreement for the visualization of the tubes was k=0.54 for 16-row MDCT-VH and k=1 for 64-row MDCT-VH. CONCLUSION: This study demonstrated the feasibility of evaluating the female reproductive system by MDCT-VH. 64-Row MDCT-VH could be an alternative diagnostic technique in the infertility workup algorithm. A larger study is in progress to validate these encouraging results.

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