Standardization of hysterosalpingography and selective salpingography: a valuable adjunct to simple opacification studies

Norbert Gleicher; Michael Parrilli; Linda Redding; Donna Pratt; Vishvanath Karande

doi:10.1016/s0015-0282(16)55558-7

Diagnostics Tubal and Uterine Imaging

Standardization of hysterosalpingography and selective salpingography: a valuable adjunct to simple opacification studies

Gleicher N, Parrilli M, Redding L, Pratt D, Karande V

Published December 1992 Fertility and Sterility, 58(6), 1136-1141

DOI 10.1016/s0015-0282(16)55558-7 PMID 1459262

RRM Academy Synopsis

Abnormal-looking fallopian tubes show higher salpingography pressure

In selective salpingography, tubes that looked normal on X-ray had significantly lower pressures than abnormal-looking tubes. This 1992 study of 30 women with infertility found that this test reflects only the tube tested. In the standard test, the womb may affect pressure.

Key Findings

Thirty women with infertility had hysterosalpingography, selective salpingography, or both; 13 (43%) had uterine müllerian anomalies.
Of 58 oviducts, 37 (64%) had abnormal contrast studies and 21 (36%) had an apparently normal pattern of opacification.
Tubes judged normal by opacification had significantly lower perfusion pressures than tubes judged diseased (P = 0.001).
Hysterosalpingography pressures were obtained in 29 of 30 patients; the authors report they may be affected by uterine factors and reflect only the oviduct of least resistance.
One patient with an entirely normal-looking contrast study had elevated pressures; laparoscopy showed a tube that had lost its normal smoothness and felt more rigid.

Interpretation

The study is a diagnostic series of 30 women at one infertility center. The team fixed the injection rate and the delivery system, so pressure differences came from the patient. Tubes were grouped as normal or abnormal by X-ray appearance. The authors suggest that tubal disease can make the tube stiffer, so many abnormal tubes resist perfusion and show higher pressures, and that abnormal pressure may be another index of tubal disease. The authors note that laparoscopy was not available in every case, so they could not report a correlation between perfusion pressures and tubal findings at laparoscopy.

RRM Context

Tubal assessment evaluates one physical reason conception may fail. A pressure reading adds a measure of tube stiffness to what X-ray images show. Finding the cause of infertility before choosing treatment is a core principle of restorative reproductive medicine.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

To investigate the correlation between opacification and perfusion pressures during hysterosalpingography (HSG) and selective salpingography under the assumption that the latter may add to the diagnostic capabilities of the procedures.

Design

Perfusion pressures were uniformly evaluated by standardizing injection volume per time interval of contrast medium and the delivery system. Pressures were measured in a closed system through a digital manometer and recorded on tracing paper.

Setting

Fully ambulatory gynecoradiology suite at academically affiliated infertility center.

Patients

Thirty infertility patients.

Intervention

Hysterosalpingography and selective salpingography for diagnostic purposes.

Main Outcome Measures

Correlation between opacification patterns and perfusion pressures.

Results

The evaluation of perfusion pressures during HSG is unreliable because they may be affected by uterine factors and will only reflect the oviduct of least resistance. In contrast, perfusion pressures during selective salpingography are reflective of only the investigated tube. They appear to lie within a functionally normal range of up to 350 mm Hg. Tubes by opacification judged as normal exhibited a pressure range of 429 +/- 376 mm Hg, which was significantly lower than that of abnormally appearing oviducts (957 +/- 445 mm Hg; P = 0.001).

Conclusions

The concomitant performance of perfusion pressure studies during selective salpingography further enhances the diagnostic capability of selective salpingography over HSG in the diagnostic evaluation of fallopian tubes.

Topics

Diagnostics › Tubal and Uterine Imaging › Hysterosalpingography · Research Methods › Measurement and Statistics › Instrument Development and Validation

Norbert Gleicher, Michael Parrilli, Linda Redding, Donna Pratt, Vishvanath Karande

N Gleicher, Mike Parrilli, M Parrilli, L Redding, D Pratt, V Karande

PMID 1459262 1459262 DOI 10.1016/s0015-0282(16)55558-7 10.1016/s0015-0282(16)55558-7 Gleicher et al. 1992, Gleicher 1992

Keywords

Female, Humans, Hysterosalpingography/standards, Infertility, Female/diagnostic Imaging, Perfusion, Pressure

Standardization of hysterosalpingography and selective salpingography: a valuable adjunct to simple opacification studies

Abnormal-looking fallopian tubes show higher salpingography pressure

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

Related research

Keywords