Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China.
Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangdong, China Zhujiang Hospital, Southern Medical University, Guangzhou (H.L.).
J Ultrasound Med. 2019 Aug;38(8):2169-2180. doi: 10.1002/jum.14914. Epub 2018 Dec 31.
We aim to retrospectively analyze the diagnostic image quality of transvaginal 4-dimensional hysterosalpingo-contrast sonography from infertile patients and determine the significant influencing factors.
A total of 445 patients visiting infertility clinics were included in the study, of which 167 were primary infertile and 278 were secondary infertile. The factors were recorded, including age; examination time; infertility type; history of pelvic inflammatory disease, pelvic surgery, intrauterine surgery, and ectopic pregnancy; endometrial thickness; uterine position; ovarian position; 2-dimensional image quality; intravasation quantity, position, and time; balloon volume; and the dosage of contrast agent or the sterile saline solution. All the factors were compared among different diagnostic image quality groups. The method of rank logistic regression analysis was adopted to analyze the risk factors affecting the diagnostic image quality.
Among the 445 infertile patients, 124 (27.9%) patients had intravasation occur during transvaginal 4-dimensional hysterosalpingo-contrast sonography. The diagnostic image quality between the 2 sonographers was consistent (Cronbach's alpha, 0.993). Different intravasation quantities, positions, and times; increased of balloon volume; and history of pelvic surgery were substantial risk factors for the diagnostic image quality. The diagnostic image quality diminished with the increase of intravasation. In the patient with cornual intravasation, the diagnostic image quality was substantially worse than that with non-cornual intravasation. Moreover, early onset of intravasation seriously affected the diagnostic image quality.
In conclusion, intravasation affected the diagnostic image quality, especially early cornual massive intravasation.
本研究旨在回顾性分析不孕患者经阴道四维子宫输卵管超声造影的诊断图像质量，并确定其显著影响因素。
本研究共纳入 445 名就诊于不孕不育门诊的患者，其中原发不孕 167 例，继发不孕 278 例。记录患者的年龄、检查时间、不孕类型、盆腔炎、盆腔手术、宫内手术、异位妊娠病史、子宫内膜厚度、子宫位置、卵巢位置、二维图像质量、注液量、注液位置和时间、球囊体积、造影剂或无菌生理盐水剂量等因素，并对不同诊断图像质量组间的各项因素进行比较。采用秩和 logistic 回归分析方法分析影响诊断图像质量的危险因素。
在 445 例不孕患者中，124 例（27.9%）患者在经阴道四维子宫输卵管超声造影时发生注液。两位超声医师的诊断图像质量一致性较好（Cronbach's alpha 系数为 0.993）。不同的注液量、注液位置和注液时间、球囊体积增加、盆腔手术史是影响诊断图像质量的显著危险因素。随着注液量的增加，诊断图像质量逐渐下降。在宫角注液患者中，诊断图像质量明显差于非宫角注液患者。此外，注液早期发生严重影响诊断图像质量。
总之，注液会影响诊断图像质量，尤其是早期宫角大量注液。
