Sonohysterography : An Evaluation of the Uterine Cavity

Abstract

Until recently, investigation of the uterine cavity was dependent upon various paraclinical investigation such as hysterosalpingography (HSG), more rarely CT scanning and magnetic resonance imaging, and dilatation and curettage, all of which have their drawbacks, risks, or deficiencies. ^(1,2) Transvaginal sonography (TVS) has completely transformed the diagnostic approach of the uterine cavity. Because of the proximity of the probe to the organs being explored, the images obtained are of high resolution. ^(1,3) In certain physiological and nonphysiological situation, intracavitary fluid dis- charges (fluid retention) distend the uterine cavity and improve sonographic contrast.⁽⁴⁾ Distension can also be obtained artificially by instilling a solution into the cavity inducing a veritable sonographic hysterography (Sonohysterography, SH) for evalu- ating the uterine cavity and describing intracavitary abnormalities. ^(5-7) Sonohysterography was described in 1984 by Richman et al, ⁽⁸⁾ who used transabdo minal technique for determining tubal patency. The development of transvaginal transducers has made it possible to refine this technique as a result of improved depiction of the endometrial cavity. Sonohysterography increases the diagnostic sen sitivity and specificity of transvaginal ultrasound potentially decreases the number of invasive procedures, while helping direct appropriate mana gement in cases requiring tissue diagnosis. ⁽⁹⁾ Indications for sonohysterography include both clinical and sonographic findings. Clinical indica tions include abnormal vaginal bleeding, in case of menometrorrhagia in women of child-bearing age or postmenopausal bleeding, or unexplained infertility. Sonographic findings indications include a thicken ing of the endometrial interface that is out of phase with the patient's menstrual history, the presence of a uterine leiomyoma of indeterminate location, or a poorly defined endometrium.⁽⁹⁾