Mario Borghi

Virtual hysteroscopy by multidetector computed tomography

Currently accepted techniques that evaluate the uterus and female reproductive system in the infertility workup algorithm include hysterosonography, hysteroscopy and hysterosalpingography. Based on high speed multidetector computed tomography (MDCT) which can acquire high-quality volumetric data of the pelvic region in a single brief scan, MDCT virtual hysteroscopy is proposed as a developing, non-invasive alternative diagnostic procedure for the evaluation of uterine pathology and other gynecologic disorders. Findings of the technique are illustrated.

Multidetector computed tomography virtual hysterosalpingography in the investigation of the uterus and fallopian tubes

OBJECTIVE To compare the efficacy of multidetector CT virtual hysterosalpingography (MDCT-VH) with conventional X-ray hysterosalpingography (HSG) in the evaluation of patients with diagnosis of infertility. METHODS Sixty patients with diagnosis of infertility scheduled to perform a HSG, were evaluated with 16-row (n=50) and 64-row (n=10) MDCT-VH. In 35 patients the examination was performed without a tenaculum. The HSGs were carried out using standard technique. The HSG and MDCT-VH findings were compared. The duration for both examinations and patient discomfort were documented. The sensitivity and specificity of MDCT-VH for the detection of uterine pathology and tubal obstruction were calculated using the exact binomial method. Agreement between the two methods was assessed by the Cohens kappa method (k). RESULTS The mean duration for MDCT-VH (16 and 64-rows) was 5+/-3 min, whereas for HSG was 28+/-3. The MDCT-VH without a tenaculum was the procedure with less patient discomfort. Sensitivity, specificity and inter-method agreement for the detection of uterine pathology were 100%, 92% and k=0.92 for 16-row MDCT-VH and 100%, 100% and k=1 for 64-row MDCT-VH, respectively. Sensitivity and specificity for detection of tubal obstruction were 80% and 80% for 16-row MDCT-VH and 100% and 100% for 64-row MDCT-VH, respectively; inter-method agreement for the visualization of the tubes was k=0.54 for 16-row MDCT-VH and k=1 for 64-row MDCT-VH. CONCLUSION This study demonstrated the feasibility of evaluating the female reproductive system by MDCT-VH. 64-Row MDCT-VH could be an alternative diagnostic technique in the infertility workup algorithm. A larger study is in progress to validate these encouraging results.