1.Diagnostic image quality of hysterosalpingography: ionic versus non ionic water soluble iodinated contrast media
H Mohd Nor ; KJ Jayapragasam ; BJJ Abdullah
Biomedical Imaging and Intervention Journal 2009;5(3):1-9
Objective: To compare the diagnostic image quality between three different water soluble iodinated contrast media
in hysterosalpingography (HSG).
Material and method: In a prospective randomised study of 204 patients, the diagnostic quality of images obtained
after hysterosalpingography were evaluated using Iopramide (106 patients) and Ioxaglate (98 patients). 114 patients who
had undergone HSG examination using Iodamide were analysed retrospectively. Image quality was assessed by three
radiologists independently based on an objective set of criteria. The obtained results were statistically analysed using
Kruskal-Wallis and Mann-Whitney U test.
Results: Visualisation of fimbrial rugae was significantly better with Iopramide and Ioxaglate than Iodamide. All
contrast media provided acceptable diagnostic image quality with regard to uterine, fallopian tubes outline and peritoneal
spill. Uterine opacification was noted to be too dense in all three contrast media and not optimal for the assessment of
intrauterine pathology. Higher incidence of contrast intravasation was noted in the Iodamide group. Similarly, the
numbers of patients diagnosed with bilateral blocked fallopian tubes were also higher in the Iodamide group.
Conclusion: HSG using low osmolar contrast media (Iopramide and Ioxaglate) demonstrated diagnostic image
qualities similar to HSG using conventional high osmolar contrast media (Iodamide). However, all three contrast media
were found to be too dense for the detection of intrauterine pathology. Better visualisation of the fimbrial outline using
Ioxaglate and Iopramide were attributed to their low contrast viscosity. The increased incidence of contrast media
intravasation and bilateral tubal blockage using Iodamide are probably related to the high viscosity.