Hysterosalpingo-Contrast Sonography HyCoSy -- normal study

Описание: This an example of normal fallopian tubes as depicted with the imaging method of hysterosalpingo-contrast sonography (HyCoSy). For this study I have used the ultrasound contrast medium SonoVue.

Damage to the fallopian tubes is a frequent cause of female infertility, mainly due to ascending pelvic inflammatory disease from sexually transmitted infections. The evaluation of tubal patency is an important part of the diagnostic work-up of infertility.

In hysterosalpingo-contrast sonography (HyCoSy) three imaging techniques must be combined: transvaginal ultrasound, sonohysterography and sonosalpingography. The fallopian tube is a poor ultrasonic reflector, lacking interfaces that produce clear tissue outlines. To evaluate the fallopian tubes by ultrasound, a sonographic contrast medium must be infused. These positive contrast agents outline the course of the lumen of the fallopian tubes, producing a hyperechoic appearance in real time. The latest contrast media, gas microbubbles, show a substantial harmonic response at low acoustic pressure making them clearer and visible for longer. Currently, microbubble shells are composed of albumin, galactose, lipids, or polymers. In the second generation of contrast agents developed, the air in the bubble has given its place to higher molecular weight gases resulting in more stable bubbles. SonoVue, Optison, and Luminity / Definity are the main representatives of the second generation agents. SonoVue is characterized by a microbubble structure consisting of a gas of low solubility (sulfur hexafluoride) stabilized by a phospholipid monolayer shell and has been clinically tested for hysterosalpingo-contrast sonography.

Several prospective and retrospective studies support HyCoSy as a reliable and reproducible screening procedure for subfertility. Technical difficulties should be expected in obese patients, when the uterus is acutely retroverted or oblique, in the presence of large fibroids projecting over the adnexal regions, when multiple loops of bowel are present, or the ovaries are located beyond the penetration of the ultrasound beam. The fallopian tube cannot be seen completely in a single scanning plane due to its tortuosity. Visualization of the entire tube requires multiplanar scanning by an experienced sonographer who is able to quickly manipulate the transvaginal probe to visualize the different anatomical parts of the tubes. A learning curve of a few hundred HyCoSy procedures is necessary to optimize technique.

Hysterosalpingo-contrast-sonography combines principles of transvaginal ultrasound and sonohysterography with those of radiographic hysterosalpingography, while maintaining competitive diagnostic accuracy. It is well-suited as a screening tool in the initial imaging of subfertility, allowing simultaneous evaluation of ovarian reserve and morphology, uterine cavity contour and myometrial structure, and tubal anatomy and patency.

Stavros Mousourakis (Mussurakis), MD, FRCR
Clinical Radiologist
Ultrasound, Fetal & Women's Imaging Specialist

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