Multimodal Hysterosalpingography for One-Stop Assessment of Tubal Patency and Fimbrial Function: A Prospective Diagnostic Trial

Tubal infertility is a major cause of female infertility, necessitating accurate evaluation of fallopian tube patency and fimbrial function. While a laparoscopic dye test (LDT) remains the gold standard, its invasiveness limits clinical use. This study proposes a multimodal hysterosalpingography approach combining four-dimensional (4D) contrast-enhanced ultrasound (4D HyCoSy), two-dimensional color Doppler imaging (2D-CIS), and 2D baseline scanning with saline-infused uterine cavity contrast (2D-FS + SIPS) for noninvasive, comprehensive tubal assessment.

A prospective study included 136 infertile patients (242 fallopian tubes) from March 2022 to August 2025. All patients underwent multimodal hysterosalpingography. Diagnostic performance was compared against LDT, and correlations between fimbrial morphology and tubal function were analyzed.

Multimodal integration significantly improved diagnostic accuracy: sensitivity for patency, partial obstruction, and total obstruction was 93.94%, 85.29%, and 90.7%, respectively, with a specificity of 97.49%, outperforming single-modality examinations (p < 0.05). The addition of 2D-FS + SIPS enhanced visualization of fimbrial structures, increasing detection rates from 34.7% to 62.1% (p < 0.001). Abnormal fimbrial morphology strongly correlated with tubal dysfunction, with abnormality rates rising from 16.9% (patent) to 61.1% (partially obstructed) and 95.1% (obstructed) (p < 0.001). Multimodal evaluation showed 88.6% concordance with LDT (kappa = 0.765), sensitivity of 92.9%, and specificity of 94.4%.

Multimodal hysterosalpingography provides a noninvasive, one-stop solution for precise evaluation of tubal patency and fimbrial function. It identifies fimbrial pathology as a key factor in distal tubal obstruction, offering valuable insights for etiology diagnosis and personalized treatment of tubal infertility.