Imaging keeps major role in uterine cavity

Hysterosalpingography is the radiographic evaluation of the uterine cavity and fallopian tubes after injection of radiopaque contrast through the cervical canal. The first hysterosalpingography, performed in 1910, was considered to be the first interventional radiological procedure. A properly performed hysterosalpingography provides information on the contour of the uterine cavity and the width of cervical canal. Further injection outlines the cornua isthmic and ampullary portions of the tubes and evaluates the degree of spillage. If a properly performed hysterosalpingography shows the uterine cavity to be normal, it is unlikely that other modalities will reveal abnormalities.1 The main indication for hysterosalpingography is female infertility, either with or without repeated miscarriage. It can also be used to investigate pelvic tract pain, congenital or anatomic abnormalities, anomalies of the menstrual cycle, and abnormal menses. It is still occasionally used as a preoperative imaging study for women who are about to undergo uterine or tubal surgical procedures.2 Research has indicated that hysterosalpingography has a sensitivity of 58% and a positive predictive value of 28.6% for polypoid lesions and a sensitivity of 0% for endometrial hyperplasia. The same study showed the technique to have sensitivities of 44.4% for the detection of uterine malformations and 75% for intrauterine adhesions.3 The main contraindication of hysterosalpingography is probable pregnancy. Performing the examination before the ovulation phase (between days seven and 10 in the menstrual cycle) reduces the likelihood of inadvertently examining a pregnant woman.2 The examination should also be avoided in cases of active intrapelvic inflammation because of potential risk of diffusion and vaginal or uterine bleeding. It should not be performed in cases of severe cardiac or renal deficiency or shortly after uterine or tubal surgery.4