Virtual Hysterosalpingography: A New Diagnostic Technique for the Study of the Female Reproductive Tract

Abstract

Imaging studies in infertile patients have become an important aspect in the evaluation of the female reproductive tract. Although conventional hysterosalpingography (HSG) remains the study most commonly requested, new technologies have been introduced which overcome the limitations associated with HSG. Over the past decade the development of multidetector computed tomography (MDCT) technology, with a capacity for exceptionally high spatial and temporal resolution, has revolutionized the examination of the heart, colon (Carrascosa et al., Acta Gastroenterol Latinoam 33(3):145–149, 2003), and airways. Virtual hysterosalpingography is an emerging application that combines the capabilities of multidetector CT with the established technique of hysterosalpingography, allowing for a more comprehensive evaluation of the female reproductive system.

The technique itself is simple, short, and relatively painless. Our experience with over 7,000 patients showed that the images generated for analysis through multiplanar reconstruction, maximum intensity projection (MIP), volume rendering, and virtual endoscopy demonstrated a clear visualization of the uterine cavity (Carrascosa et al., Abdom Imaging 33(4):381–387, 2008), fallopian tubes, and extrauterine structures, allowing the diagnosis of polyps, myomas, uterine anomalies, and tubal pathology (Carrascosa et al., Eur J Radiol 67(3):531–535, 2008) with a high degree of accuracy. The simplicity of the study together with the lack of discomfort is certainly one of its greatest advantages. The use of ionizing radiation could be considered a relative disadvantage; however, the exposure is lower when compared to conventional HSG at our center.

Our main objective in writing this chapter is to share our experience with this new technology, to describe optimal protocols for improved image acquisition, to fully discuss and illustrate post-procedure processing and image reconstruction, and finally, to show images of the various diagnoses one is able to make by using virtual HSG. We are confident that this evolving technology will eventually replace conventional HSG for the evaluation of the female reproductive tract given its many diagnostic advantages.