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Current update on status of saline infusion sonohysterosalpingography

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Abstract

The purpose of this article is to elucidate the current role of saline infusion sonohysterosalpingography (SIS) in evaluation of various uterine pathologies. SIS improves visualization of the endometrium and pathologies related to endometrial cavity, as well as it can simultaneously assess tubal patency. SIS provides high-resolution images, and three-dimensional (3D) reformatted images provide excellent orientation for radiologists as well as the clinicians about the underlying pathologies. This article will discuss imaging technique, indications, pearls, and pitfalls in imaging, diverse disease pathologies, and ultimately compare performance of SIS among other different imaging modalities. SIS as an adjunct imaging modality results in a greater diagnostic yield for diverse uterine pathologies.

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References

  1. Aslam M, Ijaz L, Tariq S, Shafqat K. Meher-Un-Nisa, Ashraf R, Kazmi T. Comparison of transvaginal sonography and saline contrast sonohysterography in women with abnormal uterine bleeding: correlation with hysteroscopy and histopathology. Int J Health Sci (Qassim). 2007;1:17–24.

  2. Sankpal RS, Confino E, Matzel A, Cohen LS. Investigation of the uterine cavity and fallopian tubes using three-dimensional saline sonohysterosalpingography. Int J Gynaecol Obstet. 2001;73(2):125–129.

  3. Christianson MS, Legro RS, Jin S, et al. Comparison of sonohysterography to hysterosalpingogram for tubal patency assessment in a multicenter fertility treatment trial among women with polycystic ovary syndrome. J Assist Reprod Genet. 2018;35 (12) 2173–2180.

  4. WHO Scientific Group on Recent Advances in Medically Assisted Conception & World Health Organization. (1992). Recent advances in medically assisted conception: report of a WHO scientific group [meeting held in Geneva from 2 to 6 April 1990]. World Health Organization. https://apps.who.int/iris/handle/10665/38679

  5. Berridge DL, Winter TC. Saline Infusion Sonohysterography: Technique, Indications, and Imaging Findings. J Ultrasound Med. 2004;23(1):97–112.

  6. Yang T, Pandya A, Marcal L, et al. Sonohysterography: principles, technique and role in diagnosis of endometrial pathology. World J Radiol. 2013;5:81–87.

  7. Frost AV, Routon SG, Angtuaco TL. Saline Infusion Sonohysterography: Key Findings and How to Perform the Examination. Contemp Diag Radiol. 2016;39(8):1–5.

  8. Lindheim SR, Sprague C, Winter TC. Hysterosalpingography and Sonohysterography: Lessons in Technique. Am J Roentgenol. 2006;186(1):24–29.

  9. Allison SJ, Horrow MM, Kim HY, Lev-Toaff AS. Saline-infused Sonohysterography: Tips for Achieving Greater Success. RadioGraphics. 2011;31(7):1991–2004.

  10. Rahimi S, Marani C, Renzi C, Natale ME, Giovannini P, Zeloni R. Endometrial Polyps and the Risk of Atypical Hyperplasia on Biopsies of Unremarkable Endometrium: A Study on 694 Patients With Benign Endometrial Polyps: Int J Gynecol Pathol. 2009;28(6):522–528.

  11. Grasel RP, Outwater EK, Siegelman ES, Capuzzi D, Parker L, Hussain SM. Endometrial Polyps: MR Imaging Features and Distinction from Endometrial Carcinoma. Radiology. 2000;214(1):47–52.

  12. Tabrizi AD, Vahedi A, Esmaily HA. Malignant endometrial polyps: Report of two cases and review of literature with emphasize on recent advances. J Res Med Sci. 2011;16(4):574–579.

  13. Lane BF, Wong-You-Cheong JJ. Imaging of endometrial pathology. Clin Obstet Gynecol 2009; 52:57–72.

  14. Bhaduri M, Tomlinson G, Glanc P. Likelihood Ratio of Sonohysterographic Findings for Discriminating Endometrial Polyps From Submucosal Fibroids. J Ultrasound Med. 2014;33(1):149–154.

  15. Parker WH. Etiology, symptomatology, and diagnosis of uterine myomas. Fertil Steril. 2007;87(4):725–736.

  16. Wallach EE, Vlahos NF. Uterine Myomas: An Overview of Development, Clinical Features, and Management: Obstet Gynecol. 2004;104(2):393–406.

  17. Bree RL, Bowerman RA, Bohm-Velez M, et al. US Evaluation of the Uterus in Patients with Postmenopausal Bleeding: A Positive Effect on Diagnostic Decision Making. Radiology. 2000;216(1):260–264.

  18. Reed SD , Newton KM, Clinton WL, et al. Incidence of endometrial hyperplasia. Am J Obstet Gynecol 2009;200:678.e1–678.e6.

  19. Chandra V , Kim JJ, Benbrook DM, Dwivedi A, Rai R. Therapeutic options for management of endometrial hyperplasia. J Gynecol Oncol 2016;27:712–749.

  20. Laifer-Narin SL, Ragavendra N, Lu DS, Sayre J, Perrella RR, Grant EG. Transvaginal saline hysterosonography: characteristics distinguishing malignant and various benign conditions. Am J Roentgenol. 1999;172(6):1513–1520.

  21. Braun MM, Overbeek-Wager EA, Grumbo RJ. Diagnosis and management of endometrial cancer. Am Fam Physician. 2016;93:468–474.

  22. Byun JY, Kim SE, Choi BG, Ko GY, Jung SE, Choi KH. Diffuse and focal adenomyosis: MR imaging findings.RadioGraphics. 1999;19(Suppl 1):s161–s170.

  23. Verma SK, Lev-Toaff AS, Baltarowich OH, Bergin D, Verma M, Mitchell DG. Adenomyosis: Sonohysterography with MRI Correlation. Am J Roentgenol. 2009;192(4):1112–1116.

  24. Reinhold C, Tafazoli F, Mehio A, et al. Uterine Adenomyosis: Endovaginal US and MR Imaging Features with Histopathologic Correlation. RadioGraphics. 1999;19(Suppl 1):s147–s160.

  25. Siskin GP, Tublin ME, Stainken BF, Dowling K, Dolen EG. Uterine Artery Embolization for the Treatment of Adenomyosis. Am J Roentgenol. 2001;177(2):297–302.

  26. Conforti A, Alviggi C, Mollo A, De Placido G, Magos A. The management of Asherman syndrome: a review of literature. Reprod Biol Endocrinol. 2013;11:118.

  27. AAGL Practice Report: Practice Guidelines for Management of Intrauterine Synechiae. J Minim Invasive Gynecol. 2010;17(1):1–7.

  28. Fong K, Kung R, Lytwyn A, et al. Endometrial evaluation with transvaginal US and hysterosonography in asymptomatic postmenopausal women with breast cancer receiving tamoxifen. Radiology. 2001;220(3):765–773.

  29. Dessole S, Farina M, Rubattu G, Cosmi E, Ambrosini G, Battista NG. Side effects and complications of sonohysterosalpingography. Fertil Steril. 2003;80(3):620–624.

  30. Kamel HS, Darwish AM, Mohamed SA. Comparison of transvaginal ultrasonography and vaginal sonohysterography in the detection of endometrial polyps. Acta Obstet Gynecol Scand. 2000;79(1):60–64.

  31. Dueholm M, Forman A, Jensen ML, Laursen H, Kracht P. Transvaginal sonography combined with saline contrast sonohysterography in evaluating the uterine cavity in premenopausal patients with abnormal uterine bleeding. Ultrasound Obstet Gynecol. 2001;18(1):54–61.

  32. Jacques E, Verma U, Whitted RW. Accuracy of saline infusion sonohysterography in diagnosis of uterine intracav itary pathology. Obstet Gynecol. 2001;97:S18.

  33. Chittacharoen A, Theppisai U, Linasmita V, Manonai J. Sonohysterography in the diagnosis of abnormal uterine bleeding. J Obstet Gynaecol Res. 2000;26(4):277–281.

  34. de Vries LD, Dijkhuizen FP, Mol BW, Brölmann HA, Moret E, Heintz AP. Comparison of transvaginal sonography, saline infusion sonography, and hysteroscopy in premenopausal women with abnormal uterine bleeding. J Clin Ultrasound. 2000;28(5):217–223.

  35. Becker E, Lev-Toaff AS, Kaufman EP, Halpern EJ, Edelweiss MI, Kurtz AB. The Added Value of Transvaginal Sonohysterography Over Transvaginal Sonography Alone in Women With Known or Suspected Leiomyoma. J Ultrasound Med. 2002;21(3):237–247.

  36. Saunders RD, Shwayder JM, Nakajima ST. Current methods of tubal patency assessment. Fertil Steril. 2011;95(7):2171–2179.

  37. Socolov D, Lupaşcu IA, Danciu E, et al. Sonohysterosalpingography versus hysterosalpingography in the evaluation of uterine and tubal infertility. Rev Med Chir Soc Med Nat Iasi. 2009;113(3):803–808.

  38. Holz K, Becker R, Schürmann R. Ultrasound in the investigation of tubal patency. A meta-analysis of three comparative studies of Echovist-200 including 1007 women. Zentralbl Gynakol. 1997;119(8):366–73.

  39. Campbell S, Bourne TH, Tan SL, Collins WP. Hysterosalpingo contrast sonography (HyCoSy) and its future role within the investigation of infertility in Europe. Ultrasound Obstet Gynecol. 1994;4(3):245–253.

  40. Acholonu UC, Silberzweig J, Stein DE, Keltz M. Hysterosalpingography Versus Sonohysterography for Intrauterine Abnormalities. JSLS. 2011;15(4):471–474.

  41. Aas-Eng MK, Langebrekke A, Hudelist G. Complications in operative hysteroscopy – is prevention possible? Acta Obstet Gynecol Scand. 2017;96(12):1399–1403.

  42. Schwärzler P, Concin H, Bösch H, et al. An evaluation of sonohysterography and diagnostic hysteroscopy for the assessment of intrauterine pathology. Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol. 1998;11(5):337–42.

  43. Epstein E, Ramirez A, Skoog L, Valentin L. Transvaginal sonography, saline contrast sonohysterography and hysteroscopy for the investigation of women with postmenopausal bleeding and endometrium > 5 mm. Ultrasound Obstet Gynecol. 2001;18(2):157–162.

  44. Saidi MH, Sadler RK, Theis VD, Akright BD, Farhart SA, Villanueva GR. Comparison of sonography, sonohysterography, and hysteroscopy for evaluation of abnormal uterine bleeding. J Ultrasound Med. 1997;16(9):587–591.

  45. Cicinelli E, Romano F, Anastasio PS, Blasi N, Parisi C, Galantino P. Transabdominal sonohysterography, transvaginal sonography, and hysteroscopy in the evaluation of submucous myomas. Obstet Gynecol. 1995;85(1):42–47.

  46. Bingol B, Gunenc Z, Gedikbasi A, Guner H, Tasdemir S, Tiras B. Comparison of diagnostic accuracy of saline infusion sonohysterography, transvaginal sonography and hysteroscopy. J Obstet Gynaecol. 2011;31(1):54–58.

  47. Dueholm M, Lundorf E, Hansen ES, Ledertoug S, Olesen F. Accuracy of magnetic resonance imaging and transvaginal ultrasonography in the diagnosis, mapping, and measurement of uterine myomas. Am J Obstet Gynecol. 2002;186(3):409–415.

  48. Jha RC, Ascher SM, Imaoka I, Spies JB. Symptomatic Fibroleiomyomata: MR Imaging of the Uterus before and after Uterine Arterial Embolization. Radiology. 2000;217(1):228–235.

  49. Yamashita Y, Mizutani H, Torashima M, et al. Assessment of myometrial invasion by endometrial carcinoma: transvaginal sonography vs contrast-enhanced MR imaging. Am J Roentgenol.1993; 161:595–599

  50. Ascher SM, Arnold LL, Patt RH, et al. Adenomyosis: prospective comparison of MR imaging and transvaginal sonography. Radiology. 1994;190(3):803–806.

  51. Troiano RN. Magnetic Resonance Imaging of Mullerian Duct Anomalies of the Uterus: Top Magn Reson Imaging. 2003;14(4):269–279.

  52. Pellerito JS, McCarthy SM, Doyle MB, Glickman MG, DeCherney AH. Diagnosis of uterine anomalies: relative accuracy of MR imaging, endovaginal sonography, and hysterosalpingography. Radiology. 1992;183(3):795–800.

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Authors and Affiliations

  1. Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA

    Shruti Kumar

  2. Department of Radiology, St. Vincent’s Medical Center, Bridgeport, CT, 06606, USA

    Pankaj Nepal & Joshua Sapire

  3. Department of Radiology, University of Iowa, Iowa City, IA, 52242, USA

    Sabarish Narayanasamy

  4. Department of Radiology, Mayo Clinic Rochester, Rochester, MN, 55901, USA

    Ashish Khandelwal

  5. Department of Radiology, University of Texas Health San Antonio, San Antonio, TX, 78229, USA

    Vijayanadh Ojili

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  1. Shruti Kumar
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Correspondence to Pankaj Nepal.

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Kumar, S., Nepal, P., Narayanasamy, S. et al. Current update on status of saline infusion sonohysterosalpingography. Abdom Radiol 47, 1435–1447 (2022). https://doi.org/10.1007/s00261-022-03427-2

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  • DOI: https://doi.org/10.1007/s00261-022-03427-2

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