Department of Ultrasonography, Third Affiliated Hospital of Southern Medical University, 183 W Zhongshan Ave, 510630 Guangzhou, Guangdong, China.
J Ultrasound Med. 2013 Jul;32(7):1233-43. doi: 10.7863/ultra.32.7.1233.
This study was conducted to describe our first experience using transvaginal 4-dimensional (4D) hysterosalpingo-contrast sonography with SonoVue (Bracco International BV, Amsterdam, the Netherlands) for diagnosis of fallopian tube patency. The study was prospective and conducted in a university hospital setting. The sonographic procedures included 2-dimensional transvaginal sonography for evaluating uterine and ovarian mobility, observing intubation, and determining the initial plane and 4D hysterosalpingo-contrast sonography for observing periovarian and pelvic diffusion. Ninety-six outpatients visiting infertility clinics underwent 4D hysterosalpingo-contrast sonography. All patients finished the examination successfully. A total of 192 fallopian tubes were assessed, of which 95 (49.5%) were classified as type A (the tube was patent, and the contrast agent flowed smoothly through it), 72 (37.5%) as type B (the tube was patent, but the contrast agent did not flow smoothly inside it), and 25 (13.0%) as type C (blocked). Sixteen patients underwent laparoscopy or laparoscopy combined with hysteroscopy; 28 tubes (87.5%) were concordant with laparoscopy. The sensitivity, specificity, positive predictive value, negative predictive value, and Youden index for 4D hysterosalpingo-contrast sonography versus laparoscopy were 81.8%, 90.5%, 81.8%, 90.5%, and 0.72 respectively. In total, 92.7% of patients did not require a hospital stay after 4D hysterosalpingo-contrast sonography, and none need resuscitation. The others stayed in the hospital for clinical observation because of a severe vasovagal reaction or severe pain but received only bed rest without any medical treatment. Forty patients (41.7%) felt slight pain; 39 (40.6%) felt moderate pain; and 15 (15.6%) had a vasovagal reaction. No procedure or postprocedure complications occurred in any patient. In conclusion, 4D hysterosalpingo-contrast sonography with SonoVue is an available screening method for assessment of tubal patency and is tolerable for most patients.
本研究旨在描述我们首次使用经阴道四维（4D）超声造影（Bracco International BV，荷兰阿姆斯特丹）诊断输卵管通畅性的经验。该研究为前瞻性研究，在一家大学医院进行。超声程序包括经阴道二维超声检查评估子宫和卵巢的活动度、观察插管情况、确定初始平面，以及经阴道四维超声造影检查观察卵巢周围和盆腔扩散情况。96 名就诊于不孕不育诊所的门诊患者接受了经阴道四维超声造影检查。所有患者均成功完成检查。共评估了 192 条输卵管，其中 95 条（49.5%）为 A 型（输卵管通畅，造影剂通畅通过），72 条（37.5%）为 B 型（输卵管通畅，但造影剂内部流动不顺畅），25 条（13.0%）为 C 型（阻塞）。16 例患者接受腹腔镜或腹腔镜联合宫腔镜检查；28 条输卵管（87.5%）与腹腔镜检查结果一致。经阴道四维超声造影与腹腔镜检查的灵敏度、特异性、阳性预测值、阴性预测值和 Youden 指数分别为 81.8%、90.5%、81.8%、90.5%和 0.72。总共，92.7%的患者在经阴道四维超声造影后无需住院，且无需复苏。其余患者因严重血管迷走反应或剧烈疼痛而留在医院进行临床观察，但仅接受卧床休息，无需任何治疗。40 例（41.7%）患者感觉轻微疼痛；39 例（40.6%）患者感觉中度疼痛；15 例（15.6%）发生血管迷走反应。没有患者发生任何程序或术后并发症。总之，SonoVue 经阴道四维超声造影是一种评估输卵管通畅性的可行筛查方法，大多数患者可耐受。
