Fallopian tube disease: the cobblestone pattern as a radiographic sign

Area of Science:

• Reproductive medicine
• Diagnostic imaging

Background:

• Hysterosalpingography (HSG) is a common imaging technique for evaluating the female reproductive tract.
• Assessing tubal mucosal integrity is crucial for fertility evaluations.
• Salpingoscopy offers direct visualization of the tubal mucosa.

Purpose of the Study:

• To identify radiographic signs of mucosal damage.
• To compare hysterosalpingography (HSG) findings with direct salpingoscopy visualization.
• To prospectively evaluate the accuracy of HSG in detecting tubal mucosal abnormalities.

Main Methods:

• Prospective study involving 41 women undergoing laparoscopy.
• Hysterosalpingography (HSG) and peroperative salpingoscopy performed on 74 tubes.
• Radiographic criteria for mucosal abnormality included the 'cobblestone pattern' and absence of longitudinal radiolucent bands.
• Salpingoscopy categorized mucosal fold patterns into normal (I-II) and abnormal (III-V) classes.

Main Results:

• High agreement (89.2%, kappa=0.73) between HSG and salpingoscopy in detecting abnormal mucosal patterns.
• The 'cobblestone pattern' on HSG consistently correlated with intraluminal adhesions seen during salpingoscopy.
• HSG identified 31/74 tubes as distally nonpatent, with 26 confirmed obstructions by salpingoscopy.
• Six tubes with normal HSG findings showed intraluminal adhesions upon salpingoscopy.

Conclusions:

• The 'cobblestone pattern' on hysterosalpingography is a reliable radiographic indicator of intraluminal adhesions in hydrosalpinges.
• Normal hysterosalpingograms do not always rule out intraluminal disease in patent fallopian tubes.
• Salpingoscopy provides valuable complementary information for assessing tubal mucosal health.