Patricia Carrascosa, M. D. , Ph. D. , Carlos Capuñay, M. D

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Presentation transcript:

Two-dimensional and three-dimensional imaging of uterus and fallopian tubes in female infertility Patricia Carrascosa, M.D., Ph.D., Carlos Capuñay, M.D., Javier Vallejos, M.D., Jimena Carpio, M.D., Mariano Baronio, M.D., Sergio Papier, M.D. Fertility and Sterility Volume 105, Issue 6, Pages 1403-1420.e7 (June 2016) DOI: 10.1016/j.fertnstert.2016.04.016 Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

Figure 1 Thickening of cervical folds (arrow). (A) CT-VHSG and (B) MR-VHSG volume rendering images. (C) CT-VHSG and (D) MR-VHSG virtual endoscopy images. Fertility and Sterility 2016 105, 1403-1420.e7DOI: (10.1016/j.fertnstert.2016.04.016) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

Figure 2 Cervical stenosis (arrow). (A) CT-VHSG maximum intensity projection, (B) volume rendering, and (C) virtual endoscopy images. MR-VHSG (D) maximum intensity projection, (E) volume rendering, and (F) virtual endoscopy images. Fertility and Sterility 2016 105, 1403-1420.e7DOI: (10.1016/j.fertnstert.2016.04.016) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

Figure 3 Cervical synechiae (arrow). CT-VHSG (A) maximum intensity projection, (B) volume rendering, and (C) virtual endoscopy images. Fertility and Sterility 2016 105, 1403-1420.e7DOI: (10.1016/j.fertnstert.2016.04.016) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

Figure 4 Cervical polyp (arrow). CT-VHSG coronal (A) multiplanar reconstruction, (B) volume rendering, and (C) virtual endoscopy images. MR-VHSG sagittal (D) multiplanar reconstruction, (E) maximum intensity projection, and (F) virtual endoscopy images. Fertility and Sterility 2016 105, 1403-1420.e7DOI: (10.1016/j.fertnstert.2016.04.016) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

Figure 5 Cesarean scar (arrow). Coronal CT-VHSG (A) volume rendering and (B) maximum intensity projection images. (C) Virtual endoscopy image. Fertility and Sterility 2016 105, 1403-1420.e7DOI: (10.1016/j.fertnstert.2016.04.016) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

Figure 6 Cesarean scar (arrow). (A) Coronal MR-VHSG volume rendering image. (B) Coronal and (C) sagittal maximum intensity projections images. (D) Virtual endoscopy image. Fertility and Sterility 2016 105, 1403-1420.e7DOI: (10.1016/j.fertnstert.2016.04.016) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

Figure 7 Small cervical diverticulum (arrow). CT-VHSG (A) maximum intensity projection, (B) volume rendering, and (C) virtual endoscopy images. MR-VHSG (D) maximum intensity projection, (E) volume rendering, and (F) virtual endoscopy images. Fertility and Sterility 2016 105, 1403-1420.e7DOI: (10.1016/j.fertnstert.2016.04.016) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

Figure 8 Cervicouterine synechiae (arrow) in a partial septate uterus. (A) X-ray HSG. (B) CT-VHSG thin-slab axial image with soft tissue window. (C) CT-VHSG volume rendering image. (D) CT-VHSG virtual endoscopy image. Fertility and Sterility 2016 105, 1403-1420.e7DOI: (10.1016/j.fertnstert.2016.04.016) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

Figure 9 Uterine synechiae (yellow arrow) in a uterus with cesarean scar (red arrow). (A, B) MR-VHSG 3D volumetric time-resolved MR images showing the progressive filling of the endometrial cavity, with the presence of a central irregular filling defect. (C) CT-VHSG maximum intensity projection image. Fertility and Sterility 2016 105, 1403-1420.e7DOI: (10.1016/j.fertnstert.2016.04.016) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

Figure 10 Isolated endometrial sessile polyp (arrow). CT-VHSG (A) maximum intensity projection, (B) volume rendering, and (C) virtual endoscopy images. MR-VHSG (D) maximum intensity projection, (E) volume rendering, and (F) virtual endoscopy images. Fertility and Sterility 2016 105, 1403-1420.e7DOI: (10.1016/j.fertnstert.2016.04.016) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

Figure 11 Type II submucous myoma (arrow). CT-VHSG (A) axial multiplanar reconstruction, (B) sagittal multiplanar reconstruction, and (C) virtual endoscopy images. Fertility and Sterility 2016 105, 1403-1420.e7DOI: (10.1016/j.fertnstert.2016.04.016) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

Figure 12 Unicornuate uterus. CT-VHSG (A) maximum intensity projection, (B) volume rendering, and (C) virtual endoscopy images. MR-VHSG (D) maximum intensity projection, (E) volume rendering, and (F) virtual endoscopy images. Fertility and Sterility 2016 105, 1403-1420.e7DOI: (10.1016/j.fertnstert.2016.04.016) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

Figure 13 Bicornuate uterus. CT-VHSG (A) maximum intensity projection, (B) volume rendering, and (C) virtual endoscopy images. Fertility and Sterility 2016 105, 1403-1420.e7DOI: (10.1016/j.fertnstert.2016.04.016) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

Figure 14 Complete septate uterus. (A) CT-VHSG volume rendering and (B) virtual endoscopy. Fertility and Sterility 2016 105, 1403-1420.e7DOI: (10.1016/j.fertnstert.2016.04.016) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

Figure 15 Didelphys uterus. CT-VHSG (A) maximum intensity projection and (B) volume rendering images. There are linear filling defects within the right hemiuterus compatible with synechiae, seen on both (C) axial soft tissue and (D) virtual endoscopy images. Fertility and Sterility 2016 105, 1403-1420.e7DOI: (10.1016/j.fertnstert.2016.04.016) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

Figure 16 Normal fallopian tubes, with abundant spillage of contrast into the peritoneal cavity. CT-VHSG (A) maximum intensity projection and (B) volume rendering images. MR-VHSG (C) maximum intensity projection and (D) volume rendering images. Fertility and Sterility 2016 105, 1403-1420.e7DOI: (10.1016/j.fertnstert.2016.04.016) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

Figure 17 Normal right fallopian tube and left salpingectomy (arrow). CT-VHSG (A) maximum intensity projection and (B) volume rendering images, showing opacification of only the interstitial portion of the left tube. Fertility and Sterility 2016 105, 1403-1420.e7DOI: (10.1016/j.fertnstert.2016.04.016) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

Figure 18 Ampullary dilation of the right tube (arrow). CT-VHSG (A) maximum intensity projection and (B) volume rendering images. MR-VHSG (C) maximum intensity projection and (D) volume rendering images. Fertility and Sterility 2016 105, 1403-1420.e7DOI: (10.1016/j.fertnstert.2016.04.016) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

Figure 19 Bilateral hydrosalpinx. CT-VHSG (A) maximum intensity projection and (B) volume rendering images. MR-VHSG (C) maximum intensity projection and (D) volume rendering images. Fertility and Sterility 2016 105, 1403-1420.e7DOI: (10.1016/j.fertnstert.2016.04.016) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

Figure 20 Right hydrosalpinx with intraluminal synechiae (arrow), associated with left tubal obstruction. CT-VHSG (A) maximum intensity projection, (B) volume rendering, and (C) virtual endoscopy images. MR-VHSG (D) maximum intensity projection, (E) volume rendering, and (F) virtual endoscopy images. Fertility and Sterility 2016 105, 1403-1420.e7DOI: (10.1016/j.fertnstert.2016.04.016) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

Supplemental Figure 1 Post-processing algorithms. (A) Multiplanar reconstruction image. (B) Maximum intensity projection image. (C) Volume rendering image. (D) Virtual endoscopy view. Fertility and Sterility 2016 105, 1403-1420.e7DOI: (10.1016/j.fertnstert.2016.04.016) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

Supplemental Figure 2 Contrast intravasation to the myometrium and to the periuterine venous plexus (arrows). CT-VHSG coronal (A) multiplanar reconstruction, (B) maximum intensity projection, and (C) volume rendering images. Fertility and Sterility 2016 105, 1403-1420.e7DOI: (10.1016/j.fertnstert.2016.04.016) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

Supplemental Figure 3 Normal cervical anatomy. (A) CT-VHSG and (B) MR-VHSG maximum intensity projections, showing a normal broad cervical canal. Fertility and Sterility 2016 105, 1403-1420.e7DOI: (10.1016/j.fertnstert.2016.04.016) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

Supplemental Figure 4 (A) Classification of myomas according to their location on the uterine wall. (B) Submucous myomas, Wamsteker classification. (C) Submucous myomas, Labastida classification. Fertility and Sterility 2016 105, 1403-1420.e7DOI: (10.1016/j.fertnstert.2016.04.016) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

Supplemental Figure 5 Large Intramural myoma on uterine fundus, enlarging the uterine silhouette and deforming its contour (arrow). CT-VHSG (A) maximum intensity projection and (B) volume rendering images. MR-VHSG (C) maximum intensity projection and (D) sagittal T2-weighted images. Fertility and Sterility 2016 105, 1403-1420.e7DOI: (10.1016/j.fertnstert.2016.04.016) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

Supplemental Figure 6 Focal adenomyosis (arrow). CT-VHSG (A) coronal and (B) sagittal multiplanar reconstructions. MR-VHSG (C) coronal 3D-CUBE and (D) sagittal T2-weighted images. MR-VHSG (E) coronal and (F) axial time-resolved imaging of contrast kinetics (TRICKS) images. Fertility and Sterility 2016 105, 1403-1420.e7DOI: (10.1016/j.fertnstert.2016.04.016) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

Supplemental Figure 7 Schematic representation of uterine anomalies. Fertility and Sterility 2016 105, 1403-1420.e7DOI: (10.1016/j.fertnstert.2016.04.016) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions