Clinical Application Study on the Fallopian Tube Patency Using Real-time Harmonic Contrast Ultrasound with Low Mechanical Index

22 June 2009 0 views No Comment

Abstract:

Objectives:Fertilization and early embryonic development occur in the fallopian tube whose structural or functional abnormality may lead in infertility. Therefore, a system that can be used to accurately assess the condition of fallopian tube not only facilitates finding the cause of infertility, but also provides important reference for its clinical treatment.Recently, there have been many ways to clinically assess the function of fallopian tube, including hydrotubation(HDT), X-hysterosalpinography (X-HSG), uterosalpingography and laparoscopy(LPS), all of which are, to some extent, inadequate. Comparing to the other clinical ways for tubal assessment, uterosalpingosonography has its advantages of simple manipulation, noninvasiveness, and no negative effects from radiation. Additionally, assessment to uterus and uterine appendage can be concurrently conducted. Nowadays, both overseas and domestic scholars have published their reports focusing on uterosalpingosonography with contrast medium of hydrogen peroxide, carbamide peroxide, ect. and all of them have achieved satisfying outcomes. However, due to constraints of traditional ultrasonography and contrast medium, uterosalpingosonography(USSG) has been also inadequate impairing assessment of tubal function. To find a better way to diagnose fallopian tube obstruction, we adopted a method using new techniques of ultrasonography, low mechanical index real-time harmonic contrast ultrasound (LMIRHCU) with new contrast medium, fluorocarbon to demonstrate the flow and imaging of fluorocarbon in uterus and fallopian tube. Its purposes were to evaluate the fallopian tube patency and the value of clinical diagnosis in the fallopian tube patency, to provide an effective diagnosis method in the evaluation of fallopian tube patency for infertil women.Materials and MethodsTotally 39 cases of infertility had been admitted to department of gynaecology and obstetrics in our hospital during March 2006 to March 2007. After B-mode ultrasound, examination of basal body temperature and husband sperm test to exclude such etiological factors as ovaries diseases and husband infertility, the subjects were performed B-mode USSG with the contrast medium of fluorocarbon. The ultrasonography was performed with the equipment of Philips IU22 and the technique of LMIRHCU was used.Before ultrasonography, routine abdominal ultrasound was performed to examine the organs in the pelvic cavity during which the location of uterus and ovaries as well as their internal echo was observed and their sizes were measured. The uterorectal sinuses were observed to know whether there was fluid and the volume of the fluid was measured. Subsequently, the chosen ultrasonography was switched on for transcatheter injection of contrast medium under the monitoring of B-mode ultrasound. While the contrast medium was injected, the mechanic index and the gaining intensity were regulated based on the condition of the patients to achieve the best developing outcome of the contrast medium. The flow of the contrast medium in the uterine cavity, left and right fallopian tubes was observed from several sections. And the developing of the contrast medium in the left and right ovaries was observed as well. Finally, fluid or additional fluid in the uterorectal sinuses was observed. One round developing was taken from the developing of uterine cavity when ultrasonographic recording program was started and the patient that was difficult to be diagnosed could be performed repeated ultrasonographic recording. The location, size, morphology and internal echo of uterus and bilateral ovaries under routine abdominal ultrasound before contrast were recorded. The fluid and the fluid volume in the uterorectal sinuses were recorded. During the contrast, the flow rate of the contrast medium in the uterus and bilateral fallopian tubes as well as their contrast were recorded. The contrast of bilateral ovaries and the addition of uterorectal fluid were recorded. After that, based on the contrast of the uterus, bilateral fallopian tubes, bilateral ovaries and uterorectal sinuses, the respective photographic recording was reviewed for analysis. The obstruction of fallopian tube was divided into 4 types: 1) bilaterally unobstructed; 2) bilaterally obstructed; 3) unilaterally obstructed and 4) unobstructed but unsmooth flow. For those with diagnosis of suspected fallopian tube adhesion or hydrosalpinx fluid, it was indicated; for those with suspected distal occlusion of fallopian tube, fallopian tube adhesion or hydrosalpinx fluid and infertility with no cause could be found, it was recommended for further examinations of uterosalpingosonography or laparascopy. The diagnosis and all recordings of each patient was registered in detail.2. Among those 39 patients that had undergone B-modeUSSG, 20 had received X-HSG, 18 had received LPS. For those 20 cases who had undergone both X-HSG and USSG, the results of both examinations were compared and analyzed to calculate the unobstruction coincidence (%), tubal unobstruction but unsmooth flow coincidence (%), tubal obstruction coincidence (%) and the total coincidence (%) of the two groups. The software package for social sciences (SPSS 10.0) was used for statistical analysis. The statistical methods were Kappa coefficient test in the datas of datametched-pairs counted. K coefficient and P numerus were yielded using Kappa coefficient test. K coefficient was the anastomosis coefficient of the two results. Generally, k≥0.7, the anastomosis coefficient was better; 0.7＞k≥0.4, the anastomosis coefficient was common; k＜0.4, the anastomosis coefficient was bad. P＜0.05, the two results were significant in the statistics; P＞0.05, the two results were not significant in the statistics. The other 19 cases who had undergone both USSG and LPS was also compared and analyzed with the same method for the tubal unobstruction coincidence (%), tubal unobstruction but unsmooth flow coincidence (%), tubal obstruction coincidence (%) and the total coincidence (%) and K coefficient and P numerus.ResultsThe total 40 fallopian tubes in the 20 cases undergoing X-HSG had 17 unobstructed fallopian tubes, 12 unobstructed but unsmooth flow tubes, 11 obstructed fallopian tubes. Their USSG demonstrated 20 unobstructed fallopian tubes, 11 unobstructed but unsmooth flow tubes and 9 obstructed tubes. The comparison and analysis of the two groups of results showed an unobstruction coincidence of 86.5%, an unobstructed but unsmooth flow coincidence of 87%, obstruction coincidence of 100% and the total coincidence of 90%. By SPSS 10.0 analysis, K coefficient was 0.806 and P numerus was 0.000, the anastomosis coefficient of the two results were significant and better in the statistics.2. The total 36 fallopian tubes of 18 cases undergoing LPS had 14 unobstructed fallopian tubes, 14 unobstructed but unsmooth flow tubes and 8 obstructed tubes. And their USSG demonstrated 12 unobstructed tubes, 15 unobstructed but unsmooth flow tubes and 9 obstructed tubes. By comparison and analysis of the two groups data, we got the unobstruction coincidence of 92.3%, unobstruction but unsmooth flow coincidence of 89.7%, obstruction coincidence of 94.1% and the total coincidence of 91.7%. By SPSS 10.0 analysis, K coefficient was 0.872 and P numerus was 0.000, the anastomosis coefficient of the two results were significant and better in the statistics. Among the 19 cases, 2 had suspected fallopian tube hydrosalpinx fluid and 1 had suspected adhesion and obstruct. The 3 cases were definitely diagnosed by laparoscopy.Conclusions1. LMIRHCU has advantages of clear contrast and accurate judgement, which is advanced technology to the previous USSG. The application of contrast medium in the study is also a qualitative advancement, which overcomes the poor contrast of fallopian tube to its surrounding tissues in the pelvic cavity and poor imaging effects by previous USSG. The new technique also overcomes the shortcomings of short developing time resulting in incomplete observation of the whole developing course.2. LMIRHCU have high anastomosis coefficient with those of X-HSG and LPS with almost the same diagnostic results. It not only has the advantages of the both, but also is advantageous over the two. It facilitates avoiding negative effects of radiation on the human body and permits concurrent analysis to the uterus and the uterine appendage. It has advantages of simple and safe manipulation, economical and noninvasiveness, which has been demonstrated as an effective way in clinical practice to examine the fallopian tube obstruction. It has widespread application perspective and deserves further clinical studies.