Another study of only 19 women discovered HSG and sonohysterography were both 100% sensitive, and conventional TVUS was only 52% sensitive for detecting intrauterine adhesions compared with hysteroscopy [69]. Additional studies have shown HSG to be 75% to 81% sensitive and 80% specific compared with hysteroscopy in diagnosing intrauterine adhesions [70,71]. Antibiotic administration or prophylactic use of antibiotics is at the discretion of the referring physician if there is a prior history of PID or if hydrosalpinx is noted at the time of the study. Although HSG may provide useful information about the uterine cavity, such as the presence of adhesions, it is not reliable in categorizing MDAs and has been largely replaced by MRI and 3-D US for assessment of the uterine cavity in recurrent pregnancy loss. Female Infertility MRI Pelvis MRI provides accurate assessment of uterine abnormalities potentially contributing to infertility such as MDA [67], adenomyosis [72], and leiomyomas [73]. On both TVUS and MRI, a fundal cleft >1 cm can be used to diagnose a bicornuate uterus and differentiate it from a septate uterus (fundal cleft <1 cm) [67]. A fundal indentation <5 mm above the interostial line can also be used for identification of a bicornuate uterus [74]. In 24 cases of surgically proven MDA, MRI was 100% accurate, 2-D TVUS was 92% accurate, and hysterosalpingogram was only 16.7% accurate in the classification of MDA [67]. MRI demonstrates 78% to 88% sensitivity and 67% to 93% specificity in detecting adenomyosis, typically thickening of the junctional zone, often with T2 hyperintense foci [72]. Nondegenerated fibroids are classically well circumscribed with low T2 signal. The imaging features of degenerated fibroids can vary greatly on MRI, however [73]. Although MRI may be useful in detecting intrauterine adhesions, no large studies comparing its efficacy to hysteroscopy have been performed [75].
Female Infertility. Another study of only 19 women discovered HSG and sonohysterography were both 100% sensitive, and conventional TVUS was only 52% sensitive for detecting intrauterine adhesions compared with hysteroscopy [69]. Additional studies have shown HSG to be 75% to 81% sensitive and 80% specific compared with hysteroscopy in diagnosing intrauterine adhesions [70,71]. Antibiotic administration or prophylactic use of antibiotics is at the discretion of the referring physician if there is a prior history of PID or if hydrosalpinx is noted at the time of the study. Although HSG may provide useful information about the uterine cavity, such as the presence of adhesions, it is not reliable in categorizing MDAs and has been largely replaced by MRI and 3-D US for assessment of the uterine cavity in recurrent pregnancy loss. Female Infertility MRI Pelvis MRI provides accurate assessment of uterine abnormalities potentially contributing to infertility such as MDA [67], adenomyosis [72], and leiomyomas [73]. On both TVUS and MRI, a fundal cleft >1 cm can be used to diagnose a bicornuate uterus and differentiate it from a septate uterus (fundal cleft <1 cm) [67]. A fundal indentation <5 mm above the interostial line can also be used for identification of a bicornuate uterus [74]. In 24 cases of surgically proven MDA, MRI was 100% accurate, 2-D TVUS was 92% accurate, and hysterosalpingogram was only 16.7% accurate in the classification of MDA [67]. MRI demonstrates 78% to 88% sensitivity and 67% to 93% specificity in detecting adenomyosis, typically thickening of the junctional zone, often with T2 hyperintense foci [72]. Nondegenerated fibroids are classically well circumscribed with low T2 signal. The imaging features of degenerated fibroids can vary greatly on MRI, however [73]. Although MRI may be useful in detecting intrauterine adhesions, no large studies comparing its efficacy to hysteroscopy have been performed [75].