Ultrasound contrast hysterosalpingography--evaluation as an outpatient procedure

Ultrasound contrast hysterosalpingography (HSG) uses intrauterine contrast media to increase the diagnostic value of plain transvaginal ultrasound enabling the uterine cavity contour to be assessed and allowing tubal patency to be determined. We present our experience using both negative (sterile saline) and positive (Echovist, Schering) contrast media in 27 patients presenting with a wide range of gynaecological disorders. This is the first report comparing the use of the two contrast media with plain ultrasound on a purely outpatient basis. We have found ultrasound saline HSG to be superior for the delineation of the uterine cavity and we predict that this will become a first line investigation for assessing the configuration of the uterine cavity. However, although Echovist could be demonstrated flowing through patent fallopian tubes, we found ultrasound contrast HSG to be insufficiently accurate in the determination of tubal patency and do not feel that it can replace conventional X-ray HSG. We review the literature on this technique and discuss its future role in gynaecological imaging.