P–334 CT virtual Histerotomography: a new method for the evaluation of fallopian tube patency and pelvic organs in patients seeking pregnancy
Authors: Hentschke M , Vasconcelos N , Badalott. Teloken I , Agostini A , Dornelles V , Siqueira D , Trindade V , Petracco Á , Badalotti M 
Published: August 2021

Abstract

Study question
Can computerized virtual histerotomography (CT-HSG) be used for the evaluation of fallopian tube patency and pelvic organs in patients seeking pregnancy? Summary answer: CT-HSG seems to be an adequate test for the evaluation of fallopian tube patency, pelvic organs, and the uterine cavity.

What is known already
CT-HSG is a minimally invasive exam, which diagnoses variations in the female reproductive system, uses low radiation doses and is well tolerated by patients. It simultaneously evaluates the uterine wall, cavity and cervix, tubes, and adjacent pelvic structures. The exam enables virtual navigation, which consists of the endoluminal view of the cervical canal and uterine cavity and allows 3D reconstruction of images. The exam remains underused to assess infertility, but previous studies have shown potential and its use may be widespread.

Study design, size, duration
Retrospective cohort study, that included data from 317 women seeking pregnancy, between January/2019 and January/2021. The CT-HSG was indicated for infertility (90.3%) and RPL (0.9%) investigation, and for the evaluation of tubal stump in patients who were planning the tubal reversal surgery (8.8%). Patients filled out a questionnaire about their pain symptoms and data were collected from electronic records.

Participants/materials, setting, methods
The study analyzed patients’ clinical characteristics and image findings regarding tubes, uterine cavity, and ovaries. For the exam, a catheter was positioned in the cervix, where the contrast medium (iopromide) was injected through an infusion pump at 0.30 ml/s, for a total of 20ml. The tomographic slices were obtained at the 50th second. The CT-HSG images were interpreted by the same gynecologist and radiologist. Data were analyzed using SPSS version 20.0.

Main results and the role of chance
Women and partners’ mean age was 32.7 ± 5.6 and 34.6 ± 7.7 years, respectively, and women’s mean BMI was 28.4 ± 6.4 Kg/m². The pain scale was applied in 103 patients, who reported 5.4±3.2 pain scale scores at the end of the exam. Among the infertile patients 67% were nulliparous. Regarding the exam findings, most of the uterus findings were normal (72.6%). The variations found were uterine malformations (including unicornuate uterus, uterus didelphys, bicornuate uterus, septate uterus, and arcuate uterus), synechia, fibroids, endometrial polyps, adenomyosis and retractions/lateralizations that may suggest endometriosis. The tubal findings on the right/left (%) were: 65/67.5 patent horn; 18.9/17.7 obstructed tubes; 4/41 dilatation/hydrosalpinx and 9.4/9.1 with previous history of tubal ligation or salpingectomy; 1.5% of the tubal evaluation were inconclusive. Eleven from 317 patients had to repeat the exam due to occurrences during the execution (for example, improper catheter positioning, cuff fall, stenosis of the internal cervical ostium, severe pain).The 3D analysis and virtual navigation assist in the findings assessment, in addition to being simpler for the gynecologists evaluation.

Limitations, reasons for caution
The sample size is small due to the exam being a new technique. Patient follow-up and correlation with laparoscopy and hysteroscopy, when indicated, are under studied.
Wider implications of the findings: The exam seems to be promising for assessing infertility, RPL and the tubal stump. Moreover, it may be a good option to hysterosalpingography as it seems to cause less pain and allows to evaluate the ovaries and the uterine contour, added to 3D reconstructions and to virtual uterine navigation.

Trial registration number
Not applicable