Value Of Magnetic Resonance Hysterosalpingography In Diagnosis Of Female Infertility

Objective:1.Through in vitro experiments to explore the optimal signal concentration ratio of Gd-DTPA contrast agent diluted when use MR-LAVA scan in order to improve MR-HSG tissue’ contrast.2.Compared with X-HSG,analyze the diagnostic value of magnetic resonance hysterosalpingography(MR-HSG)using the best signal concentration ratio Gd-DTPA as contrast agent in the evaluation of female infertility in order to obtain a one-stop image technology for diagnosing female infertilityMethods:1.Using MR-LAVA sequence scans 11 types different dilution concentrations contrast agents,which was maked according to the ratio of Gd-DTPA to normal saline was 0: 1,1: 1,1: 4,1: 9,1:19,1:29,1:39,1:49,1:99,1: 199,1:0,to obtain the image which was transmit to the post-processing workstation to measure the signal intensity(SI)to selecting the best SI concentration ratio,repeating 3 times.2.Collected 16 patients who came to our hospital without contraceptive measures and had a regular sex life 12 months or more and failed to get pregnant from June 2019 to January 2020,performed MR-HSG and X-HSG inspection randomly when 3 to 7 days after menstruation,on the same day,divided into A and B two groups according to the randomly examination order.Mann-Whitney rank sum test is used to compare the difference between X-HSG and MR-HSG results and each the differences in the diagnosis of tubal patency in groups A and B of item examines,and analyzes the diagnostic value of MR-HSG by ROC curve.Results:1.There was no statistically significant difference between the three data(P=0.993),the signal intensity reached the highest peak at the dilution concentration of Gd-DTPA was 25mmo1/L,that is,the concentration ratio of the three results had the best signal at 1:19.2.Results of the clinical study on the value of MR-HSG diagnosis of female infertility: 16 patients were collected and 32 fallopian tubes were included in the statistical study.1)The results of X-HSG examination are 12 lateral unobstructed,9 lateral partially unobstructed,11 lateral obstructed,and10 lateral hydrosalpinx;MR-HSG results are 17 lateral unobstructed,8 lateral partially unobstructed,and 7 lateral unblocked tubes,4 lateral hydrosalpinx,1case polycystic ovary syndrome,3 cases small pelvic effusion,3 cases uterine fibroids,1 cases small cervical cyst were found.There was no statistically significant in difference tubal patency results of the two examinations(Z=-1.335,P=0.182),but has statistically significant in difference of the ability to find disease(Z =-3.069,P = 0.002).The ability of diagnosising lesions in the uterus and pelvis of MR-HSG was stronger.2)Randomly divided into groups A and B according to the examination order.A group of 10 patients had 20 lateral tubes.Results(1)X-HSG examination:6 lateral were unobstructed,8 lateral were partially unobstructed,6 lateral were obstructed,(2)MR-HSG examination:10lateral were unobstructed,7 lateral were partially unobstructed,3 lateral were obstructed.6 patients in group B had a total of 12 lateral fallopian tubes.Results(1)X-HSG examination: 6 lateral were unobstructed,1 lateral were partially unobstructed,5 lateral were obstructed,(2)MR-HSG examination:7 lateral were unobstructed,1 lateral were partially unobstructed,4 lateral were obstructed.Comparing the differentiation between the results of the two examinations to diagnosis the patency of the fallopian tubes.There is no statistically significant difference between the two examinations in groups A and B respectivly(X-HSG:Z=-2.90,P=0.772),(MR-HSG: Z=-1.07,P=0.915).3)ROC curve of the diagnostic performance of MR-HSG for tubal patency,area A = 0.911,sensitivity: 76.2%,specificity: 90.9%.4)X-HSG and MR-HSG examination NRS scores of pain were 4.63±5.25 ? 2.81±2.00.statistically significant in difference between the two examinations(Z=-2.445,P = 0.014).Conclusion:1.When MR-HSG is scanned with LAVA sequence,the optimal dilution concentration of contrast agent GD-DTPA is 25mmol/L,that is,the signal is best when the concentration ratio is 1:19.2.Compared with X-HSG,MR-HSG diagnosis of tubal patency is more specificity and accurate,and more comfortable.In addition conventional MRI examination can be clear find intrauterine and extrauterine lesions to provide more evidences for the diagnosis of infertility.In short,MR-HSG combined with MRI imaging has significancy value in the diagnosis of female infertility,and it is expected to become a one-stop new imaging technology for the diagnosis of female infertility.