| Objective:The purpose of this study was to propose new methods for imaging the form and patency of fallopian tube by magnetic resonance hysterosalpingography (MR HSG) using some clinically available MR sequence(MR hydrographic sequemce,LAVA sequence,TRICKS sequence). And compare the Image quality of hydrographic sequence,LAVA sequence and TRICKS sequence (Image quality grading,SNR and CNR)and assessment capabilities of tubal patency.Materials and methods:1,Eighty New Zealand white female rabbits weighing 2-2.5 kg were used for this project. All animals were purpose-bred and in good health.Rabbit uterine horns (n=120) were catheterized trans-vaginally.20 rabbits of MR HSG was obtained using MR hydrographic sequence after injection of 6.0-15.OmL of physiological saline solution using hand to push the syringe.8 fallopian tubes were ligated to occlusion,8 fallopian tubes were narrowed and the other 14 were unaltered. And other 60 rabbits of MR HSG were obtained using 3D dynamic enhanced sequence after injection of 6.0-15.0ml of Gd-DTPA using High-pressure syringe in 0.02 ml/s,part of the rabbits were scanned by TRICKS sequence and then scanned by LAVA sequence; Otherwise,the rest were sanned by LAVA sequence and then scanned by TRICKS sequence.20 fallopian tubes were ligated to occlusion,20 fallopian tubes were narrowed and the other 80 were unaltered.and then the MR hydrographic sequence,3 D-LAVA sequence, TRICKS sequence being scanned and the received images were transmitted to thworkstation for post-processing to obtain MR HSG images.Analysis of MR HSG images diagnosis of tubals patency accuracy and peritoneal fluid situation of exudative.separately evaluated by two observers the dynamic enhanced sequence(hydrographic sequence,AVA,RICKS sequence)imagings of SNR,NR and the three-dimendional reconstruction image quality.Then on the measurement results and images quality statistic;2,Observed Indicators:①Image quality:Whether the sharp edge of the fallopian tube;②The morphology of Tubal:Whether to display the morphology of normal, stenosis, orl occlusion;③Patency:whether there is the overflow of liquid around end of the tubal and next to the colon trench; 3,Standard of image quality grading:The method of reference Danias grade 5:1= Image quality is poor and not diagnose;2= The tube structure can identify, but obviously vague or obvious artifacts, diagnosis is not reliable;3= Tube structure can identify, but blurred or moderate artifacts, to diagnose;4= Image quality is good, clear structure, mild blurred or artifacts that can confirm the diagnosis;5= Image quality, sharp edges, to a clear diagnosis. Greater than or equal to 3 to diagnostic requirements are divided into two groups were analyzed SNR, CNR no difference in image quality;4,Evaluation criteria for one:Used to evaluate the image quality and tubal morphology, Whether the sharp edge of tube, clearly show the bilateral tubals of normal, stenosis, occlusion;5,Second evaluation criteria:Used to determine whether the fallopian tube lumen of normal,stenosis, occlusion and the situation of patency(Intraabdominal fluid has spilled on behalf of tubal patency), There are five cases:①The fallopian tube lumen Normal is normal and patency (True positive):Oviduct should be tubular high signal, edge smooth, around the end of fallopian tubes and next to the colon trench had the spill of liquid;②The fallopian tube;'umen Normal is normal and patency (false positive):the tubal should be high signal, edge smooth, around the end of fallopian tubes and next to the colon trench,had not the spill of liquid;③Unilateral tubal of stenosis (true positive):One side of the fallopian tube was limitations narrow, around the end of fallopian tubes and next to the colon trench had the spill of liquid;④Unilateral tubal of stenosis (false positive):One side of the fallopian tube was narrow, around the end of fallopian tubes and next to the colon trench had not the spill of liquid;⑤Unilateral tubal of occlusion (true negative):one side of the tubal was distal,around the end of fallopian tubes and next to the colon trench had not the spill of liquid.Results:1,Assessment of the uterine cavity and patency of the fallopian tubes remains impossible without saline injection and Gd-DTPA. The occlusive and the narrowed fallopian tubes were clearly demonstrated on 3D MR HSG after saline and Gd-DTPA injection; 2,Diagnostician 1 and 2 were that the 3D dynamic enhanced sequence of image quality is better than hydrographic sequence and the TRICKS sequence of image quality is better than LAVA. hydrographic sequence, LAVA, TRICKS sequential images of SNR, CNR by rank sum test P<0.05, And the mean rank of the three sequences are TRICKS> LAVA> hydrographic sequence. LAVA,ICKS of SNR, CNR comparison P<0.05,has statistically significant. Observer land 2 were that the TRICKS sequence of image quality better than the LAVA and hydrographic sequence, P<0.0001, Observer 1 and 2 shows good agreement;3,Based on the first evaluation criteria:the compliance rates were 100%;4,Based on the second evaluation criteria:Evaluation of tubal patency sensitivity, specificity, compliance rates were 100% and 100% and 100%,37.5% and 39.4% and 71.4%,75% and 89.2% and 93.3%. hydrographic sequence, LAVA and TRICKS sequences consistent with the evaluation of tubal patency rate by the test had statistically significant, p<0.05.Conclusion:1,MR HSG can clearly show the morphology of normal,stenosis and occlusion of the fallopian tube and the situation of patency.3D dynamic contrast-enhanced sequence of image quality should be better than hydrographic sequence. And the 3D TRICKS sequence of image quality (image quality classification, SNR, CNR) of the dynamic enhanced sequence is superior to LAVA sequence;2,The TRICKS sequence of specificity,compliance rate of assessment in the tubal situation of patency is better than LAVA sequence and hydrographic sequence;3,MR HSG is a promising non-invasive evaluation of uterine tubal patency imaging method, after further improvement, could be used for clinical diagnosis of tubal infertility. |
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