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Wang L, Chen X, He M, Hu S, Ren Q, Qi X, Tan Y, Luo H. Evaluation of tubal patency based on peak injection pressure in four-dimensional hysterosalpingo-contrast sonography among infertile females: a preliminary study. Quant Imaging Med Surg 2024; 14:3461-3472. [PMID: 38720834 PMCID: PMC11074734 DOI: 10.21037/qims-23-1569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/18/2024] [Indexed: 05/12/2024]
Abstract
Background Although the application of four-dimensional hysterosalpingo-contrast sonography (4D-HyCoSy) has relatively good diagnostic accuracy for assessing the patency of the fallopian tubes, the evaluation process mainly relies on morphological findings of the fallopian tubes and pelvic cavity. The purpose of this study was to explore the relationship of peak injection pressure during 4D-HyCoSy and tubal patency to provide a quantitative indicator for the evaluation of fallopian tube patency. Methods This study included infertile patients who underwent 4D-HyCoSy and laparoscopic chromopertubation (LC) between 2020 and 2022, with LC serving as the reference test for assessing tubal patency. For the HyCoSy procedure, the ultrasound contrast agent was injected automatically using a liquid injection machine, and real-time pressure values were recorded. Patients were classified based on tubal patency status in LC as bilaterally patent, unilaterally patent, or bilaterally nonpatent. The average peak injection pressure and contrast agent volume of different groups were compared. Receiver operating characteristic (ROC) curve analysis was employed to determine the cutoff value. Results A total of 268 infertile patients were enrolled in the study. With LC as the standard examination, the sensitivity and specificity of 4D-HyCoSy in diagnosing nonpatent fallopian tubes were 91.1% and 95.1%, respectively. In general, peak injection pressure was observed to gradually increase as tubal patency decreased (P<0.001), with average peak injection pressures of 233.5±66.3, 338.8±99.8, and 469.6±63.1 mmHg in the bilaterally patent, unilaterally patent, and bilaterally nonpatent groups, respectively. The volume of contrast agent used in patients in the bilaterally nonpatent group was significantly lower than that in the other two groups (P<0.01), with average volumes of 22.7±6.3, 24.3±9.3, and 18.9±9.2 mL, respectively. When one fallopian tube was patent, the area under the curve (AUC) for distinguishing obstruction from patency of the other fallopian tube was 0.827, with a sensitivity of 79.8% and a specificity of 74.3% (cutoff value: 254.3 mmHg). Similarly, when one fallopian tube was nonpatent, the AUC was 0.866, with a sensitivity of 90.6% and a specificity of 78.3% (cutoff value: 401.3 mmHg). Conclusions Peak injection pressure during 4D-HyCoSy demonstrates promising diagnostic performance in evaluating fallopian tube patency in infertile patients.
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Affiliation(s)
- Ling Wang
- Department of Ultrasound, West China Second Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, China
| | - Xin Chen
- Department of Ultrasound, West China Second Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, China
| | - Min He
- Department of Ultrasound, West China Second Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, China
| | - Sha Hu
- Department of Ultrasound, West China Second Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, China
| | - Quanlin Ren
- Department of Ultrasound, West China Second Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, China
| | - Xiaoying Qi
- Department of Ultrasound, West China Second Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, China
| | - Yifei Tan
- Department of Ultrasound, West China Second Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, China
| | - Hong Luo
- Department of Ultrasound, West China Second Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, China
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Sun X, Cai J, Yu H, Zhang T, Zhang L. Revolutionizing Fallopian Tube Evaluation in Infertility: Transvaginal Sonography Case Study. Int J Womens Health 2023; 15:1895-1899. [PMID: 38050586 PMCID: PMC10693778 DOI: 10.2147/ijwh.s435879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 11/16/2023] [Indexed: 12/06/2023] Open
Abstract
Background Transvaginal four-dimensional hysterosalpingo-contrast sonography (TVS 4D-HyCoSy) is a pivotal diagnostic tool in the assessment and management of infertility. Conventionally, a 20mL syringe is employed for contrast agent injection, either at a constant or pulsatile pressure. However, in cases of bilateral fallopian tube obstruction, continued injection can lead to discomfort and excessive pressure within the uterine cavity, necessitating discontinuation of the examination. Case Presentation In this illuminating case study, a patient underwent TVS 4D-HyCoSy due to infertility concerns. Initial contrast agent injection failed to visualize both fallopian tubes, accompanied by acute pain. Bilateral tubal obstruction was diagnosed, prompting an innovative approach. A 2.5mL syringe was chosen for pulsed injection, leading to successful visualization of patency in one fallopian tube. Remarkably, the patient achieved natural pregnancy within three months of the examination. Conclusion Pulsed injection using a small-volume syringe emerges as a promising technique in cases of fallopian tube obstruction during TVS 4D-HyCoSy. This method not only enhances patient comfort but also improves the likelihood of visualizing fallopian tube patency, contributing to accurate infertility assessments. As a supplementary technique, it addresses limitations associated with constant pressure injection and offers a novel approach to enhance diagnostic success.
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Affiliation(s)
- Xiaofeng Sun
- Department of Ultrasound, Shenzhen Baoan Women’s and Children’s Hospital, Shenzhen, Guangdong Province, 518102, People’s Republic of China
| | - Junhong Cai
- Department of Ultrasound, Shenzhen Baoan Women’s and Children’s Hospital, Shenzhen, Guangdong Province, 518102, People’s Republic of China
| | - Hongkui Yu
- Department of Ultrasound, Shenzhen Baoan Women’s and Children’s Hospital, Shenzhen, Guangdong Province, 518102, People’s Republic of China
| | - Ting Zhang
- Department of Ultrasound, Shenzhen Baoan Women’s and Children’s Hospital, Shenzhen, Guangdong Province, 518102, People’s Republic of China
| | - Lanlang Zhang
- Department of Hemodialysis, Fuyong People’s Hospital of Baoan District, Shenzhen, Guangdong Province, 518103, People’s Republic of China
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