| Infertility is a worldwide medical health problem that haunts about 80 million to 110 million of the population.In recent years,with many women delaying childbirth and open-minded about sex,the trend of infertility is increasing.Tubal infertility accounts for 30%-40%of the causes of infertility in women.Evaluating the patency of fallopian tubes is an important part of infertility examination,and accurately evaluating of fallopian tubes can provide a great value for the treatment of infertility.There were some methods for evaluating the patency of fallopian tubes:uterine car’bon dioxide ventilation,tubal fluid surgery,laparoscopy with dye,X-Ray hysterosalpingography(HSG),hysterosalpingocontrast sonography(HyCoSy)and magnetic resonance hysterosalpingography(MR-HSG),and so on.At present,there are three kinds of methods commonly used for the assessment of fallopian tubes.Laparoscopy with dye is an invasive examination with high cost,complex operation.It is not suitable as a means of routine screening.HSG is currently the first choice to assess the patency of the fallopian tubes,however,it provides limited extratubal information and exposure to ionizing radiation.Hysterosalpingo-foam sonography(HyFoSy)is another commonly used examination for fallopian tube patency.It has a similar diagnostic accuracy to HSG,but is strongly correlated to the operator and therefore less reproducible.MR-HSG can not only evaluate the patency of fallopian tubes,but also provide a comprehensive evaluation of infertility and avoid the damage of ionizing radiation,which has become a hot topic study.The limitations of published reports:At present,less than 20 MR-HSG studies have been published(9 in English,7 in Chinese),there is few studies compared with traditional HSG or laparoscopy with dye as the gold standard,its diagnostic effectiveness needs to be further verified.Secondly,in the existing MR-HSG research,although the MR scanning technology of hysterosalpingography and the tubal contrast agent are constantly improving and optimizing,the display of fallopian tubes in the existing literature is still not ideal.Purpose:1.The visualization of fallopian tubes on MR-HSG should be improved by optimizing magnetic resonance technique and the magnetic resonance contrast agent.2.Comparison between Magnetic Resonance Hysterosalpingography and conventional Hysterosalpingography conducted on the same day for the diagnostic effectiveness.3.A comprehensive assessment of the female reproductive system morphological abnormalities on MR-HSG examination provided the valuable diagnosis for infertile women.Besides,the results of the study can be used as a reference for other female infertility research.Methods:1.To optimize the contrast agent for MR-HSG.Considering the effect of the proton density and viscosity on the MRI signal,taking into account the safety of the contrast agent and the convenience of the contrast agent preparation,15 kinds of contrast agents with different concentrations were stored in the test tube in vitro,and the signal intensity was observed and recorded under 1.5T and 3.0T MR.Run each test three times and take the mean to eradicate possible errors.Seven kinds of contrast agents with high signal were slected for the next examination.The experiment repeated 5 times and a total of 35 cases of infertile women completed the examination.Two experienced radiologists calculated the signals of the uterine uterus,fallopian tube and pelvic contrast agent,and selected the best fit for MR-HSG examination.2.Comparison the MR-HSG and HSG in the fallopian tubes.Thirty-seven cases of infertile women aged 20-40 were selected,HSG examination and MR-HSG examination were carried out on the same day.The sensitivity,specificity,positive predictive value,negative prediction value,kappa value and AUC value of MR-HSG in the diagnosis of tubal smoothness were calculated with HSG as the gold standard,which was used for statistical analysis.In addition,the visualization of the each parts of the fallopian tubes in MR-HSG and HSG was evaluated.Assessment includes four segments:ampulla,fimbria,isthmus and interstitial part.3.Application of MR-HSG in evaluating the etiology of female infertility.Retrospective analysis of the data of 1021 infertile women with MR-HSG,the uterus,ovary and other abnormalities were observed in the pelvic MR image,the patency of the fallopian tube was assessed on hysterosalpingography.Among them,406 patients were divided into primary infertility group and secondary infertility group,comparing the differences between the two groups in clinical baseline data,MR diagnosis and the level of hormone.Selecting the parameters with P value less than 0.1 for multivariate logistic regression analysis,the risk factors related to primary infertility and secondary infertility were obtained.It can help to make the plan of clinical treatment.Results:1.The signal intensity of each concentration under 3.0T is higher than that of 1.5T,and the concentration of 1:100(GD-DTPA/I350)has higher signal intensity than other proportion of contrast agent in both magnetic fields.The signal intensity among GD-DTPA/I350,GD-DTPA/1320 and GD-DTPA/I300 groups was close,and there was no statistical difference between them.However,the signal intensity of the three groups was higher than 1:30 Gd-DTPA/saline.There were significant differences between the saline and iodine contrast agents at different concentrations.In vitro and in vivo,the signal intensity was highest at 1:30 concentration in the Gd-DTPA/saline group on 1.5T and 3T MR.2.MR-HSG and HSG imaging showed good consistency in tubal diagnosis(AUC=0.911),with a sensitivity of 0.821 and a specificity of 1.000.The positive and negative predicted values were 1.000 and 0.872,respectively.The consistency between HSG and MR-HSG is good(the average kappa of three raters is 0.835).In HSG the patent fallopian tubes were 54.8%(34/62),while MR-HSG accounted for 62.9%(39/62).Two patients with bilateral tubal obstruction and one unilateral tubal obstruction on HSG were shown to be unobstructed on MR-HSG.The visualization of the fallopian tubes was observed in all cases except for tubal obstruction.Of these,97.4%cases were clearly displayed in the ampulla,followed by the fimbria(87.5%).The image of interstitial and isthmus were observed in 82.1%and 66.7%,respectively.The display of MR-HSG and HSG in each parts of fallopian tubes is comparable,and there is no significant difference between the two groups(p>0.05)3.In the evaluation of the female infertility of 1021 cases,tubal infertility factors accounted for 42.6%,uterine infertility factors accounted for 34.2%,ovarian infertility factors accounted for 46.8%.The ovarian factor is mainly consisted of polycystic ovary syndrome.The fallopian tube factor is mainly on the partially obstructed.The uterine factor is mainly on the adenomyosis.There were no abnormalities in 187 cases(1 8.3%),one abnormality in 544 cases(43.8%),two abnormalities in 313 cases(30.7%),and three abnormalities in 7,2%cases.In the comparison between primary infertility and secondary infertility,there was a significant difference in age and education between the two groups:the average age of primary infertile women was younger than that in the secondary infertility group.There are significant statistical differences between primary infertile women with higher education than those with secondary infertility.Tubal disease,adenomyosis,uterine intrauterine adhesion showed a significant positive correlation with secondary infertility.PCOS is more common in primary infertility,and there are significant statistical differences between primary and secondary groups.Of the six basic serum sex hormones and anti Miillerian Hormone hormones tested,only serum testosterone was statistically different between primary and secondary groups.In the multi-factor logistics regression analysis,there were significant statistical differences between the two groups in age,educational level,unobstructed fallopian tube,uterine adhesion and adenomyosis in the primary infertility group and secondary infertility group.Conclusions:1.The concentration of 1:100 GD-DTPA/I350 mixed contrast agent with 3.0T MR-HSG can obtain the highest signal intensity for the display of the fallopian tube.2.MR-HSG can effectively assess the unobstructed fallopian tubes and obtain a direct visualization of the fallopian tubes using a mixture of contrast agents.MRI-HSG can be considered a promising imaging method for infertile women who need a comprehensive assessment of infertility and safe examination.3.3.0T MR-HSG can be a one-step-shop evaluation of fallopian tubes and other pelvic abnormalities that may cause infertility.Secondary infertile women suffer from tubal obstruction,adenomyosis and endometrial adhesion are higher than primary infertile women.MR-HSG is more suitable for the comprehensive evaluation of the etiology of patients with secondary infertility. |
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