الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Infertility is defined as failure to have a clinical pregnancy after one year of regular unprotected sexual intercourse. It is important to assess the uterus and fallopian tubes of an infertile female. Assessment of uterine factor can be achieved by variable techniques such as. Hysterosalpingography (HSG), Transvaginal ultrasound, Sonohysterography (SHG) and office hysteroscopy .Assessment of Tubal disorders is a fundamental test because the pathological conditions causing tubal blockage prevents the ovum and sperm to meet. In addition, uterine abnormalities such as uterine septum, intrauterine adhesions, endometrial polyp and submucosal myomas can interfere with implantation.
Multi-detector CT virtual hysterosalpingography is a combination of MDCT and X-ray hysterosalpingography (HSG). Unlike HSG, cervical clamping is not used so it is considered a non-invasive technique.
The aim of the current study is to assess the usefulness, advantage and disadvantage of MDCT-HSG in evaluation of female factor infertility.
In the current study, 75 females complaining of primary or secondary infertility were evaluated in the department of Diagnostic Radiology, Faculty of Medicine, and Alexandria University .64-Multi-detector CT machine was used to do virtual hystrosalpingography for all patients. The study conducted during the follicular phase between days 7 and 10 of the menstrual cycle. MRI and/or office hysteroscopy was done according to the pathology suspected by MDC-VHSG examination. Twenty-five patients suspected to have uterine cavity disorders had office hysteroscopic examination in the infertility clinic at Obstetrics and Gynecology department.
Complication occurred in four patients, one of those patient (1.3%) experienced vasovagal attack at the end of her examination. Contrast extravasations into venous plexus occurred in three patients (4%).
Tubal patency was detected by visualization of contrast in the tubal lumen and spillage of contrast into pelvic cavity. While non-visualization of contrast in the neither tube lumen nor pelvic cavity was, denoting tubal obstruction, which was detected in 22 patients (29.3%) the most common, was unilateral tubal obstruction. It was detected in 20 patients (26.6%), however, bilateral tubal obstruction were seen in two patients (2.7%).
Mullerian anomalies were the most common uterine disorders they were identified in 22 patients (29.3%). The most common was arcuate uterus. It was detected in 17 patients (22.7%) followed by septate uterus in four cases (5.3%).
CT-VHSG misdiagnoses a case of mullerian anomaly as bicornuate uterus but with further evaluation with MRI, the final diagnosis was uterus didelphys. This patient had a triad of uterus didelphys, absent right kidney and ipsilateral obstructed right hemivagina, which constitute a syndrome called Herlyn-Werner-Wunderlich syndrome. Two cases of adenomyosis (2.7%) were detected. Five cases had multiple uterine fibroids; CT failed to identify fibroids unless it was large and /or causing bulge of the outer uterine contour. Small mural or sub serous fibroids were not seen by CT-VHSG but they were identified in MRI. One patient had large mural fibroid measured 7x7cm. It caused deviation in the course of the left tube as it had sub serous component. This patient was further evaluated by office hysteroscopy and it revealed no encroachment on the uterine cavity seen. This finding was also noted by virtual hysteroscopy.
25 patients suspected to have disorders in the uterine cavity by MDCT-VHSG had the following :mullerian anomalies were detected in six patients (24%) of patients, uterine polyp in nine 36% of patients, intrauterine adhesions in one patient ( 4%), isthmocele in one (4%) and adenomyosis in one patient (4%), hyper plastic endometrium in three patients (12%) and stenosed internal os in one patient (4%). adenomyosis was diagnosed in one patient (4%), and isthmocele in one patient (1.3%). In comparison with office hysteroscopy, MDCT- VHSG failed to diagnose endometritis and osteal fibrosis. Misdiagnosis of endometrial polyp was seen in 6/9, intrauterine adhesions diagnosed in only 1/2 patients (4%). Adenomyosis was not detected by office hysteroscopy, while hyper plastic endometrium was seen in 3/4 patients, Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of virtual hystrosalpingography for detection of intra uterine pathology, in comparison with office hysteroscopy in those 25 patients were 75.0%, 20.0%, 78.95, 16.67, and 64.0% respectively.
The mean radiation dose calculated in the current study was 5.17 ± 2.03 mGy. But with changing the factors of MA and KV was done to evaluate the effect on the resolution of images and knowing the lowest radiation dose could be used without affecting the diagnostic accuracy of the study .The lowest KV used was 80 and lowest MA used was 120 , radiation dose calculated for this patient was 1.25mGy which is lowest dose.
The advantage of V-HSG that it enables a simultaneous non-invasive evaluation of the entire uterine wall, uterine cavity, cervix and fallopian tubesin addition to evaluation of the para uterine pelvic structures.Decreased radiation exposure to staff radiologists at virtual hysterosalpingography is another advantage. However the disadvantages of this technique are mainly its high cost in comparison with HSG.