Value of "Three Dimensional Multidetector CT Hysterosalpingography" in Infertile Patients with Non-Contributory 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.