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Improvement of Hysterosalpingographic Accuracy in the Diagnosis of Peritubal Adhesions

¹ Department of Radiology, Università Cattolica del Sacro Cuore di Roma, Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Roma, Italy.
² Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore di Roma, 00168 Roma, Italy.
³ Department of Surgery, Università Cattolica del Sacro Cuore di Roma, 00168 Roma, Italy.

View larger version (98K): [in a new window]   Fig. 1. —In 34-year-old infertile woman, hysterosalpingogram shows radiographic signs of peritubal adhesions. Left tube lies vertically in ampullary segment (small black arrow). Contrast medium spills into peritoneal cavity from fimbrial end (black arrowhead) and falls to show normal inhomogeneous pattern. Note loculation of contrast medium (White arrowhead). Uterus is deviated on left side. Right tube is convoluted in ampullary segment (white arrows). Also note double-contour appearance of right tubal wall (halo effect) (large black arrows).

View larger version (44K): [in a new window]   Fig. 2. —Bar chart shows peritubal adhesions revealed by hysterosalpingography compared with laparoscopy using both adopted criteria in patent tubes. Histogram of sensitivity (Sens), specificity (Spec,) false-negative (FN), false-positive (FP), positive predictive value (PPV), negative predictive value (NPV), and overall accuracy (Acc) rates shows high diagnostic precision of hysterosalpingography when second criterion is applied. Light gray bars represent first criterion; dark gray bars represent second criterion.

View larger version (39K): [in a new window]   Fig. 3. —Bar chart shows peritubal adhesions revealed by hysterosalpingography versus laparoscopy using both adopted criteria in distally nonpatent tubes. Histogram of sensitivity (Sens), specificity (Spec), false-negative (FN), false-positive (FP), positive predictive value (PPV), negative predictive value (NPV), and overall accuracy (Acc) rates suggests that hysterosalpingography does not perform as well in patent tubes in predicting peritubal adhesions, whichever criterion is applied. Light gray bars represent first criterion; dark gray bars represent second criterion.

View larger version (81K): [in a new window]   Fig. 4A. —30-year-old infertile woman. Hysterosalpingogram shows deviation of uterus to left side with convoluted ampullary segment of left tube (small arrow) and loculation of contrast medium in peritoneum (large arrows). Right tube is convoluted with normal spillage pattern (arrowheads) in peritoneum, which appeared normal on laparoscopy.

View larger version (127K): [in a new window]   Fig. 4B. —30-year-old infertile woman. Corresponding laparoscopic image shows adhesions (double arrow) between left tube and peritoneum. U = uterus.

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