Valentini A L, Muzii L, Marana R, Catalano G F, Felici F, Destito C, Marano P
Department of Radiology , , Universita' Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy.
Radiology. 2000 Nov;217(2):521-5. doi: 10.1148/radiology.217.2.r00nv04521.
To identify radiographic signs of mucosal damage by comparing hysterosalpingography with salpingoscopy in a prospective study.
Forty-one candidates for laparoscopy underwent hysterosalpingography and peroperative salpingoscopy; at both, tubal patency was noted. Radiographic criteria for mucosal abnormality were rounded filling defects (ie, the cobblestone pattern) and the absence of longitudinal radiolucent bands in the ampullary tract. At salpingoscopy, tubal mucosa was categorized by means of inspection into five classes of fold pattern: classes I and II, normal; classes III-V, abnormal. Hysterosalpingographic and salpingoscopic results were compared by means of a two-by-two table and kappa statistics.
Seventy-four tubes were evaluated. At hysterosalpingography, 31 tubes were distally nonpatent. Of these, 26 showed a distal obstruction at salpingoscopy. None of the patent tubes at hysterosalpingography showed obstruction at salpingoscopy. The agreement between hysterosalpingography and salpingoscopy in detecting abnormal mucosal pattern was 89.2% (kappa, 0.73; P: <.001). The cobblestone pattern always corresponded to intraluminal adhesions at salpingoscopy. The absence of radiolucent bands corresponded to abnormal mucosa at salpingoscopy in four of six cases. The cobblestone pattern was found only in hydrosalpinges and never in patent tubes. Six normal patent tubes at hysterosalpingography showed intraluminal adhesions at salpingoscopy.
Results indicate that the cobblestone pattern is an effective radiographic sign of intraluminal adhesions in hydrosalpinges and suggest that intraluminal disease in patent tubes might not always be excluded on normal hysterosalpingograms.
在前瞻性研究中，通过比较子宫输卵管造影术和输卵管镜检查来确定黏膜损伤的影像学征象。
41名腹腔镜检查候选者接受了子宫输卵管造影术和术中输卵管镜检查；两者均记录输卵管通畅情况。黏膜异常的影像学标准为圆形充盈缺损（即鹅卵石样表现）以及壶腹部无纵向透亮带。在输卵管镜检查中，通过观察将输卵管黏膜分为五类褶皱模式：I类和II类，正常；III - V类，异常。通过二乘二表和kappa统计量比较子宫输卵管造影术和输卵管镜检查的结果。
共评估了74条输卵管。在子宫输卵管造影术中，31条输卵管远端不通畅。其中，26条在输卵管镜检查中显示远端阻塞。子宫输卵管造影术中通畅的输卵管在输卵管镜检查中均未显示阻塞。子宫输卵管造影术和输卵管镜检查在检测异常黏膜模式方面的一致性为89.2%（kappa值为0.73；P <.001）。鹅卵石样表现总是对应于输卵管镜检查时的管腔内粘连。在六例中有四例，无透亮带对应于输卵管镜检查时的异常黏膜。鹅卵石样表现仅在输卵管积水时发现，通畅的输卵管中从未出现。子宫输卵管造影术中六条正常通畅的输卵管在输卵管镜检查时显示管腔内粘连。
结果表明，鹅卵石样表现是输卵管积水时管腔内粘连的有效影像学征象，并提示通畅输卵管内的疾病在正常子宫输卵管造影时可能并不总是能被排除。
