value of three dimensional multidetector ct hysterosalpingography in infertile patients with noncontributory hysterosalpingography: a prospective study

Background: infertility is a common health problem requiring imaging to delineate the anatomical causes in women. three dimensional multi-detector computed tomography hysterosalpingography (3d-mdct-hsg) offers an easy workup for uterine, tubal and peritoneal factors. methods: to present the spectrum of uterine, tubal and peritoneal factors on 3dmdct- hsg and determine its diagnostic accuracy for female factor infertility, a prospective study was conducted on 25 infertile women with non-diagnostic hsg from november 2012 to march 2014. sixty four slice mdct acquired the scan during pre-ovulatory phase by contrast instillation into uterine cavity. a blinded reviewer interpreted the 3d-mdct-hsg and results were compared with final diagnosis made on hystero-laproscopy in 22 patients. diagnostic accuracy of 3d-mdct-hsg for various factors was expressed as sensitivity, specificity, positive and negative predictive value. results: mdct-hsg demonstrated definite findings in 96% of patients having nondiagnostic hsg. in this study, tubal, uterine and peritoneal abnormalities were present in 68.75%, 56% and 32% of cases, respectively. 48 tubes in 25 patients were evaluated of which 22 tubes were blocked constituting the commonest finding present in 15 (60%) patients. the sensitivity, specificity, positive predictive value and negative predictive value for uterine factors was 83.33% ,100%, 100% and 96.84%, respectively, for tubal factors 93.55%, 94.68%, 85.29% and 96.83%, respectively and for peritoneal factors 62.5%, 92%, 71.43% and 88.46%, respectively. mean effective radiation dose was 1.76±0.18 msv in mdct-hsg. conclusion: 3d-mdct-hsg can detect various factors responsible for female infertility especially tubal and uterine; in cases where hsg fails to clearly delineate the pathology.