Three-dimensional dynamic MR-hysterosalpingography: A new, low invasive, radiation-free and less painful radiological approach to female infertility

The investigators describe a new method of imaging the uterine cavity and assessing tubal patency: three-dimensional dynamic MR hysterosalpingography (3D dMR-HSG). By using a higher-viscosity contrast solution, it is possible to visualize directly the Fallopian tubes. Ten consecutive infertile women underwent both conventional HSG and 3D dMR-HSG within a 2-hour period. After cannulating the uterus, pelvic MR imaging was performed by obtaining standard axial and sagittal Tl- and T2-weighted pulse sequences. A fat-saturated 3D gradient-echo sequence then was acquired by using a phased-array body coil. Imaging was repeated after intrauterine instillation of 20 ml of a bacteria-free gadolinium-polyvidone gel solution. Two studies were nondiagnostic because the catheter slipped back into the vagina at the start of the exam. In the remaining patients, standard MR images succeeded in ruling out malformations, fibroids, endometriosis, tumors, and other pathology. The 3D dMR-HSG study demonstrated a normal uterine cavity in 8 patients and confirmed bilateral tubal patency in 6 of them. This correlated with the conventional HSG findings. In 2 patients, MR-HSG disclosed a one-sided tubal occlusion that was confirmed by x-ray HSG. In 5 of 7 patients, it was possible to visualize directly the tubes by 3D dMR-HSG. Except for 1 patient with a dislocated catheter, MR-HSG was said to be significantly less painful than the x-ray procedure. Not only does the new procedure cause less pain, but the ovaries are not exposed to ionizing radiation. In addition to being safer, the advantages of less pain and more information about the pelvic organs make up for the longer examination time and expected higher cost of 3D dMR-HSG.