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MR Hysterosalpingography with an Angiographic Time-Resolved 3D Pulse Sequence: Assessment of Tubal Patency

¹ Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Madison, WI 53792-3252.
² Present address: Department of Radiology, University of Washington, Seattle, WA.
³ Wisconsin Fertility Institute, Madison, WI.

View larger version (106K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —27-year-old woman evaluated for infertility. Initial MR angiography image (A) from series of 32 subtracted dynamic MR angiographic sequence (time-resolved imaging of contrast kinetics [TRICKS]) shows small amount of dilute gadodiamide beginning to accumulate in endometrial canal (arrow). Subsequent MR angiography images (B–D) reveal more obvious accumulation of contrast material in endometrial canal, filling of fallopian tubes (arrowheads, B), and free bilateral spill (arrowheads, D). Conventional hysterosalpingography (E) shows bilateral spill (arrows). Axial T1-weighted 3D gradient-echo images (F–I) through pelvis after dilute gadodiamide injection from inferior in pelvis (F) to superior in pelvis (I) show contrast material posterior and inferior in relation to uterus on left (arrow, F and G) from left fallopian tube and anterior and superior to uterus on right (arrow, I) from right fallopian tube.

View larger version (98K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —27-year-old woman evaluated for infertility. Initial MR angiography image (A) from series of 32 subtracted dynamic MR angiographic sequence (time-resolved imaging of contrast kinetics [TRICKS]) shows small amount of dilute gadodiamide beginning to accumulate in endometrial canal (arrow). Subsequent MR angiography images (B–D) reveal more obvious accumulation of contrast material in endometrial canal, filling of fallopian tubes (arrowheads, B), and free bilateral spill (arrowheads, D). Conventional hysterosalpingography (E) shows bilateral spill (arrows). Axial T1-weighted 3D gradient-echo images (F–I) through pelvis after dilute gadodiamide injection from inferior in pelvis (F) to superior in pelvis (I) show contrast material posterior and inferior in relation to uterus on left (arrow, F and G) from left fallopian tube and anterior and superior to uterus on right (arrow, I) from right fallopian tube.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —27-year-old woman evaluated for infertility. Initial MR angiography image (A) from series of 32 subtracted dynamic MR angiographic sequence (time-resolved imaging of contrast kinetics [TRICKS]) shows small amount of dilute gadodiamide beginning to accumulate in endometrial canal (arrow). Subsequent MR angiography images (B–D) reveal more obvious accumulation of contrast material in endometrial canal, filling of fallopian tubes (arrowheads, B), and free bilateral spill (arrowheads, D). Conventional hysterosalpingography (E) shows bilateral spill (arrows). Axial T1-weighted 3D gradient-echo images (F–I) through pelvis after dilute gadodiamide injection from inferior in pelvis (F) to superior in pelvis (I) show contrast material posterior and inferior in relation to uterus on left (arrow, F and G) from left fallopian tube and anterior and superior to uterus on right (arrow, I) from right fallopian tube.

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —27-year-old woman evaluated for infertility. Initial MR angiography image (A) from series of 32 subtracted dynamic MR angiographic sequence (time-resolved imaging of contrast kinetics [TRICKS]) shows small amount of dilute gadodiamide beginning to accumulate in endometrial canal (arrow). Subsequent MR angiography images (B–D) reveal more obvious accumulation of contrast material in endometrial canal, filling of fallopian tubes (arrowheads, B), and free bilateral spill (arrowheads, D). Conventional hysterosalpingography (E) shows bilateral spill (arrows). Axial T1-weighted 3D gradient-echo images (F–I) through pelvis after dilute gadodiamide injection from inferior in pelvis (F) to superior in pelvis (I) show contrast material posterior and inferior in relation to uterus on left (arrow, F and G) from left fallopian tube and anterior and superior to uterus on right (arrow, I) from right fallopian tube.

View larger version (129K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1E —27-year-old woman evaluated for infertility. Initial MR angiography image (A) from series of 32 subtracted dynamic MR angiographic sequence (time-resolved imaging of contrast kinetics [TRICKS]) shows small amount of dilute gadodiamide beginning to accumulate in endometrial canal (arrow). Subsequent MR angiography images (B–D) reveal more obvious accumulation of contrast material in endometrial canal, filling of fallopian tubes (arrowheads, B), and free bilateral spill (arrowheads, D). Conventional hysterosalpingography (E) shows bilateral spill (arrows). Axial T1-weighted 3D gradient-echo images (F–I) through pelvis after dilute gadodiamide injection from inferior in pelvis (F) to superior in pelvis (I) show contrast material posterior and inferior in relation to uterus on left (arrow, F and G) from left fallopian tube and anterior and superior to uterus on right (arrow, I) from right fallopian tube.

View larger version (143K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1F —27-year-old woman evaluated for infertility. Initial MR angiography image (A) from series of 32 subtracted dynamic MR angiographic sequence (time-resolved imaging of contrast kinetics [TRICKS]) shows small amount of dilute gadodiamide beginning to accumulate in endometrial canal (arrow). Subsequent MR angiography images (B–D) reveal more obvious accumulation of contrast material in endometrial canal, filling of fallopian tubes (arrowheads, B), and free bilateral spill (arrowheads, D). Conventional hysterosalpingography (E) shows bilateral spill (arrows). Axial T1-weighted 3D gradient-echo images (F–I) through pelvis after dilute gadodiamide injection from inferior in pelvis (F) to superior in pelvis (I) show contrast material posterior and inferior in relation to uterus on left (arrow, F and G) from left fallopian tube and anterior and superior to uterus on right (arrow, I) from right fallopian tube.

View larger version (142K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1G —27-year-old woman evaluated for infertility. Initial MR angiography image (A) from series of 32 subtracted dynamic MR angiographic sequence (time-resolved imaging of contrast kinetics [TRICKS]) shows small amount of dilute gadodiamide beginning to accumulate in endometrial canal (arrow). Subsequent MR angiography images (B–D) reveal more obvious accumulation of contrast material in endometrial canal, filling of fallopian tubes (arrowheads, B), and free bilateral spill (arrowheads, D). Conventional hysterosalpingography (E) shows bilateral spill (arrows). Axial T1-weighted 3D gradient-echo images (F–I) through pelvis after dilute gadodiamide injection from inferior in pelvis (F) to superior in pelvis (I) show contrast material posterior and inferior in relation to uterus on left (arrow, F and G) from left fallopian tube and anterior and superior to uterus on right (arrow, I) from right fallopian tube.

View larger version (142K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1H —27-year-old woman evaluated for infertility. Initial MR angiography image (A) from series of 32 subtracted dynamic MR angiographic sequence (time-resolved imaging of contrast kinetics [TRICKS]) shows small amount of dilute gadodiamide beginning to accumulate in endometrial canal (arrow). Subsequent MR angiography images (B–D) reveal more obvious accumulation of contrast material in endometrial canal, filling of fallopian tubes (arrowheads, B), and free bilateral spill (arrowheads, D). Conventional hysterosalpingography (E) shows bilateral spill (arrows). Axial T1-weighted 3D gradient-echo images (F–I) through pelvis after dilute gadodiamide injection from inferior in pelvis (F) to superior in pelvis (I) show contrast material posterior and inferior in relation to uterus on left (arrow, F and G) from left fallopian tube and anterior and superior to uterus on right (arrow, I) from right fallopian tube.

View larger version (148K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1I —27-year-old woman evaluated for infertility. Initial MR angiography image (A) from series of 32 subtracted dynamic MR angiographic sequence (time-resolved imaging of contrast kinetics [TRICKS]) shows small amount of dilute gadodiamide beginning to accumulate in endometrial canal (arrow). Subsequent MR angiography images (B–D) reveal more obvious accumulation of contrast material in endometrial canal, filling of fallopian tubes (arrowheads, B), and free bilateral spill (arrowheads, D). Conventional hysterosalpingography (E) shows bilateral spill (arrows). Axial T1-weighted 3D gradient-echo images (F–I) through pelvis after dilute gadodiamide injection from inferior in pelvis (F) to superior in pelvis (I) show contrast material posterior and inferior in relation to uterus on left (arrow, F and G) from left fallopian tube and anterior and superior to uterus on right (arrow, I) from right fallopian tube.

View larger version (134K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —33-year-old woman evaluated for infertility. Conventional hysterosalpingography (HSG) shows normal contour of uterine canal and free spill of iodinated contrast material from right fallopian tube, with no spill on left (arrow).

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —33-year-old woman evaluated for infertility. Subtracted dynamic 3D T1-weighted angiographic (time-resolved imaging of contrast kinetics [TRICKS]) MR HSG image of first injection of dilute gadodiamide contrast material, depicting normal endometrial canal contour, free spill of contrast material from right fallopian tube (arrow), and no spill on left.

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —33-year-old woman evaluated for infertility. Subtracted dynamic 3D T1-weighted angiographic (TRICKS) MR HSG image of second injection of dilute gadodiamide contrast material with free spill from right and left fallopian tubes (arrows).

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Images show uterine contour abnormalities on conventional and MR hysterosalpingography (HSG) studies in two women. Image from subtracted dynamic 3D T1-weighted angiographic series (time-resolved imaging of contrast kinetics [TRICKS]) in 45-year-old woman shows bilateral spill of contrast material and deformity of endometrial canal (arrow).

View larger version (156K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Images show uterine contour abnormalities on conventional and MR hysterosalpingography (HSG) studies in two women. Conventional HSG image shows bilateral spill of contrast material and deformity of endometrial canal (arrow).

View larger version (157K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —Images show uterine contour abnormalities on conventional and MR hysterosalpingography (HSG) studies in two women. Axial T2-weighted fast recovery fast spin-echo MR image shows leiomyoma (arrow) causing deformity of endometrial canal seen on MR HSG and conventional HSG.

View larger version (98K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —Images show uterine contour abnormalities on conventional and MR hysterosalpingography (HSG) studies in two women. In 31-year-old woman, subtracted dynamic 3D T1-weighted angiographic (TRICKS) MR HSG image shows indention of fundus (arrow).

View larger version (153K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3E —Images show uterine contour abnormalities on conventional and MR hysterosalpingography (HSG) studies in two women. Conventional HSG shows endometrial contour abnormality (arrow) that could represent either bicornuate or partial septate uterine malformation.

View larger version (134K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3F —Images show uterine contour abnormalities on conventional and MR hysterosalpingography (HSG) studies in two women. Coronal T2-weighted image through uterus shows normal contour along serosal surface of fundus with indentation of myometrium and endometrium into uterine canal, indicating partial septate uterus (arrow).

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