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A Hybrid Radiography/MRI System for Combining Hysterosalpingography and MRI in Infertility Patients: Initial Experience

Cynthia B. Freeman-Walsh1,2, Rebecca Fahrig3, Arundhuti Ganguly3, Viola Rieke3 and Bruce L. Daniel1

1 Department of Radiology, Stanford Hospital, Stanford, CA.
2 Present address: Department of Radiology, The Ottawa Hospital, 1053 Carling Ave., Ottawa, ON K1Y 4E9, Canada.
3 Department of Radiology, Lucas MRS Center, Stanford, CA.


Figure 1
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  		Fig. 1 —Photograph of hybrid radiography/MRI system shows position of X-ray tube (thin black arrows) and flat-panel detector (long white arrow) between two donut-shaped magnetic poles (thick black arrows) of 0.5-T magnet (Signa-SP, GE Healthcare). Foot pedals for fluoroscopy are indicated with short white arrow. Patients were placed in supine position for acquisition of MR images. For cannulation of cervix, patient was placed in lithotomy position using stirrups attached to inside of magnet.

 

Figure 2
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  		Fig. 2 —Normal study in 36-year-old woman with infertility. Superimposition of coronal MR image and hysterosalpingogram (red) can be performed because two techniques have same field of view and are obtained without moving patient between studies.

 

Figure 3
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  		Fig. 3A —40-year-old woman with infertility. Hysterosalpingography (HSG) image shows subtle contour abnormality (arrows) in lower uterine segment.

 

Figure 4
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  		Fig. 3B —40-year-old woman with infertility. HSG finding shown in A corresponds to intramural fibroid (arrow) that abuts endometrial lining on coronal T2 fast spin-echo MR image. MR image clearly shows that partially submucosal fibroid is responsible for contour abnormality shown on hysterosalpingogram (A).

 

Figure 5
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  		Fig. 3C —40-year-old woman with infertility. Superimposition of HSG (red) and MR images shows coregistration of contour abnormality on HSG and fibroid on MRI.

 

Figure 6
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  		Fig. 4A —42-year-old woman with infertility. Focal contour abnormality in uterine fundus (arrows) seen on hysterosalpingography (HSG) image was interpreted to be arcuate uterus.

 

Figure 7
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  		Fig. 4B —42-year-old woman with infertility. Coronal T2 fast spin-echo MR image confirms that contour abnormality (arrow) shown on HSG (A) corresponds to area of high T2 signal intensity, which is consistent with focal adenomyosis.

 

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