Effectiveness and radiation dose of computerized tomography virtual hysterosalpingography in the evaluation of female infertility: Systematic review and meta-analysis.

OBJECTIVE: To build evidence about the effectiveness of computerized tomography virtual hysterosalpingography (CT-VHSG) in the evaluation of female infertility and to assess the estimated radiation dose imposed. METHODS: A systematic review method was utilized to evaluate relevant diagnostic studies. Electronic database was searched from July to October 2017. Hand search was also conducted when applicable. Study quality was assessed according to standardised criteria. Heterogeneity was assessed using subjective and statistical measures. Meta-analysis was judged appropriate and conducted using Open met-analyst software utilizing the random effect model. RESULTS: Based on the assessment of risk of bias of the eligible studies, five studies were included in the final review. Random effects models showed that CT-VHSG has high diagnostic performance (pooled sensitivity 0.992 and specificity 0.98, with negative and positive likelihood ratios of 14.671 and 0.04 respectively). CT-VHSG had comparatively lesser radiation dose than conventional HSG (pooled mean effective dose 4.14 mSV vs 6 mSV respectively). CONCLUSIONS: CT-VHSG is a reliable procedure with high diagnostic performance in evaluation of the female reproductive tract. CT-VHSG can be regarded as generally safe imaging diagnostic technique in the infertility workup. In contrary to common belief, CT-VHSG has comparable or lower radiation dose than conventional HSG.

Using Magnetic Resonance Myelography to Improve Interobserver Agreement in the Evaluation of Lumbar Spinal Canal Stenosis and Root Compression.

STUDY DESIGN: Cross-sectional retrospective study designed to assess interobserver agreement. PURPOSE: To investigate if interobserver agreement using magnetic resonance imaging (MRI) in the evaluation of lumbar spinal canal stenosis and root compression can be improved upon combination with magnetic resonance myelography (MRM). OVERVIEW OF LITERATURE: The interpretation of lumbar spinal MRI, which is the imaging modality of choice, often has a significant influence on the diagnosis and treatment of low back pain. However, using MRI alone, substantial interobserver variability has been reported in the evaluation of lumbar spinal canal stenosis and nerve root compression. METHODS: Hardcopies of 30 lumbar spinal MRI (containing a total of 150 disk levels) as well as MRM films were separately reviewed by two radiologists and a neurosurgeon. At each intervertebral disk, the observers were asked to evaluate the thecal sac for the presence and degree of spinal stenoses (mild, moderate, or severe) and presence of root canal compression. Interobserver agreement was measured using weighted kappa statistics. RESULTS: Regarding lumbar spinal canal stenosis, interobserver agreement between the two radiologists was moderate (kappa, 0.4) for MRI and good (kappa, 0.6) for combination with MRM. However, the agreement between the radiologist and neurosurgeon remained fair for MRI alone or in combination with MRM (kappa, 0.38 and 033, respectively). In the evaluation of nerve root compression, interobserver agreement between the radiologists improved from moderate (kappa, 0.57) for MRI to good (kappa, 0.73) after combination with MRM; moderate agreement between the radiologist and neurosurgeon was noted for both MRI alone and after combination with MRM (kappa, 0.58 and 0.56, respectively). CONCLUSIONS: Interobserver agreement in the evaluation of lumbar spinal canal stenosis and root compression between the radiologists improved when MRM was combined with MRI, relative to MRI alone.