3.0 T MR子宫输卵管造影在女性不孕症中的诊断价值

The role of 3.0 T MR hysterosalpingography work-up in the diagnosis of female infertility

目的探讨3.0 T MR子宫输卵管造影(MR-HSG)在女性不孕症中的诊断价值。方法前瞻性收集2015年7月至2018年12月南京中医药大学附属医院20~40岁的1 052例不孕女性患者,均行MR-HSG检查,先后行盆腔平扫及子宫插管后造影检查。观察评价输卵管的通畅性及子宫、卵巢的异常。任意选取33例不孕女性,在同一天先后行X线子宫输卵管造影(HSG)和MR-HSG检查,以HSG为参考标准,采用Kappa检验和χ^2检验评价两种方法评价输卵管通畅性的一致性和差异性。结果1 021例不孕女性患者完成MR-HSG检查纳入研究。33例MR-HSG与HSG评价输卵管通畅性的一致性好,Kappa=0.88(P<0.01)。MR-HSG和HSG诊断输卵管通畅性的差异无统计学意义(χ^2=0.86,P=0.65)。1 021例患者中,187例(18.3%,187/1 021)未发现异常,834例(834/1 021)出现异常。435例(42.6%,435/1 021)有输卵管堵塞异常,其中双侧输卵管堵塞48例(4.7%,48/1 021),双侧输卵管通而不畅87例(8.5%,87/1 021),一侧通畅一侧堵塞119例(11.7%,119/1 021),一侧通畅一侧通而不畅129例(12.6%,129/1 021),一侧通而不畅一侧堵塞52例(5.1%,52/1 021)。478例(46.8%,478/1 021)出现卵巢异常,以多囊卵巢(31.1%,317/1 021)和子宫内膜异位症(23.0%,235/1 021)为主。349例(34.2%,349/1 021)显示子宫异常,以子宫腺肌症(18.4%,188/1 021)和子宫肌瘤(14.3%,146/1 021)为主。结论3.0 T MR-HSG可以有效地评估输卵管通畅性,同时能全面评价女性子宫和卵巢等异常。

Objective To evaluate the role of 3.0 Tesla magnetic resonance hysterosalpingography (MR-HSG) work-up in the diagnosis of female infertility.Methods Between July 2015 and December 2018,a total of 1 052 infertile women aged from 20 to 40 years in the Affiliated Hospital of Nanjing University of Chinese Medicine were prospectively enrolled in the study.All the patients underwent pelvic plain scanning and X-ray hysterosalpingography (HSG) followed by MR-HSG examination,and the patency of the fallopian tubes as well as the abnormalities of the uterus and ovaries were evaluated.Among which 33 cases were randomly selected.The chi-square test and Kappa test were used to compare the difference and the consistency of the two methods in the evaluation of fallopian tubes.Results MR-HSG and HSG had good consistency in evaluating tubal patency (Kappa=0.88,P<0.01),and there was no statistically significant difference between the two groups (P=0.65).The examination of MR-HSG was successfully completed in 97.1%(1 021/1 052) cases.There were 81.7%(834/1 021) cases had at least one abnormality.Bilateral tubal,uterine and ovarian abnormalitiesoccurred in 42.6%(435/1 021),34.2%(349/1 021)and 46.8%(478/1 021) cases,respectively.In which tubal abnormalities display the results as follows: bilateral obstructed 4.7%(48/1 021),bilateral poor pass 8.5%(87/1 021),one smooth one obstructed11.7%(119/1 021),one smooth one poor pass 12.6%(129/1 021),and one poor pass one obstructed 5.1%(52/1 021).Conclusion 3.0 T MR-HSG is expected to be a routineexam for evaluating female infertility,which allows a comprehensive assessment of tubal patency and other pelvic abnormalities of infertile women.