Botsikas Diomidis, Pluchino Nicola, Kalovidouri Anastasia, Platon Alexandra, Montet Xavier, Dallenbach Patrick, Poletti Pierre-Alexandre
1 Division of Radiology, Department of Imaging and Medical Information Sciences, Geneva University Hospitals, Geneva, Switzerland.
2 Division of Gynecology, Department of Obstetrics and Gynecology, Geneva University Hospitals, Geneva, Switzerland.
Br J Radiol. 2017 May;90(1073):20160947. doi: 10.1259/bjr.20160947. Epub 2017 Mar 29.
Different types of vaginal fistulas is a relatively uncommon condition in the Western world but very frequent in developing countries. In the past, conventional vaginography was the radiological examination of choice for exploring this condition. CT and MRI are now both used for this purpose. Our objective was to test the feasibility and to explore the potential role of a new CT imaging technique implementing vaginal introitus obstruction and opacification of the vagina with iodine contrast agent, to show patency of a fistula.
We describe the technical protocol of CT-vaginography as performed in Geneva University Hospitals, including vaginal catheterization with a Foley catheter and obstruction of the introitus by inflating the balloon of the catheter. We also report three cases of patients with suspected vaginal fistula who underwent CT-vaginography.
The examinations were technically successful. In one patient, it revealed the presence of fistulous pathways from the vaginal fornix along the bilateral infected surgical prostheses. In a second patient, it showed a fistula between the vagina and the necrotic cavity of a recurrent cervical cancer. In a third patient, it proved the absence of a suspected vaginal fistula.
CT-vaginography is a technically feasible CT protocol that provides anatomical and functional information on clinically suspected vaginal fistulas. Advances in knowledge: After the abandon of conventional vaginography in the era of transaxial imaging, the current modalities of imaging vaginal fistulas provide excellent anatomical detail but less functional information concerning the permeability of a vaginal fistulous pathway. We propose the use of CT-vaginography, a technical protocol that we describe in detail.
不同类型的阴道瘘在西方世界相对不常见，但在发展中国家却很常见。过去，传统阴道造影是用于探查这种情况的放射学检查方法。现在CT和MRI都用于此目的。我们的目的是测试一种新的CT成像技术的可行性，并探索其潜在作用，该技术通过碘造影剂实现阴道外口阻塞和阴道显影，以显示瘘管的通畅情况。
我们描述了在日内瓦大学医院进行CT阴道造影的技术方案，包括用Foley导管进行阴道插管以及通过充盈导管气囊阻塞阴道外口。我们还报告了3例疑似阴道瘘患者接受CT阴道造影的病例。
检查在技术上取得成功。在1例患者中，显示了从阴道穹隆沿双侧感染的外科假体存在瘘管通道。在第2例患者中，显示阴道与复发性宫颈癌的坏死腔之间存在瘘管。在第3例患者中，证实不存在疑似阴道瘘。
CT阴道造影是一种技术上可行的CT方案，可提供有关临床疑似阴道瘘的解剖和功能信息。知识进展：在跨轴成像时代传统阴道造影被弃用后，目前用于成像阴道瘘的方法提供了出色的解剖细节，但关于阴道瘘管通道通透性的功能信息较少。我们建议使用CT阴道造影，这是一种我们详细描述的技术方案。
