Radionuclide hysterosalpingography is not predictive in the diagnosis of infertility.

OBJECTIVE: To investigate whether radionuclide hysterosalpingography (radionuclide HSG), which has been suggested as a more functional approach to the diagnosis of tubal infertility than conventional patency tests, is predictive in the diagnosis of infertility. DESIGN: A retrospective analysis of data from an inquiry form containing questions about pregnancy outcome after radionuclide HSG. SETTING: University hospital-based, tertiary care infertility clinic. PATIENT(S): Two hundred sixteen women had an infertility work-up including radionuclide HSG performed between April 1986 and April 1993. Forty-one (18.9%) women were excluded from the study; 9 had moved to unknown addresses, 16 did not answer the inquiry, and 16 gave answers that were not interpretable. There were 175 (81.1%) women in the final study group. INTERVENTION(S): An inquiry form containing questions regarding pregnancy was sent to 207 women who undergone radionuclide HSG as a routine procedure in their infertility workup. MAIN OUTCOME MEASURE(S): Occurrence of pregnancy related to outcome of radionuclide HSG and its test properties calculated. RESULT(S): Bilateral or unilateral tubal transport was demonstrated by radionuclide HSG in 129 women, of whom 66 (51%) later became pregnant. Of the pregnant women, 36 (55%) had successful infertility treatment, whereas 30 (45%) reported spontaneous pregnancy. Forty-six women showed no transport at radionuclide HSG. Twenty-five (54%) of these women became pregnant, 14 (56%) with infertility treatment and 11 (44%) without infertility treatment. The predictive values of transport and no transport radionuclide HSG were 0.51 and 0.46, respectively. The sensitivity of radionuclide HSG was 0.25, and the sensitivity was 0.73. Likelihood ratios for pregnancy when radionuclide HSG showed transport and no transport were 1.03 and 0.93, respectively. CONCLUSION(S): Our data strongly indicate that a single radionuclide HSG investigation is not able to predict fertility potential.

Radionuclide hysterosalpingography does not distinguish between fertile women, before tubal sterilization, and infertile women.

The female genital tract is capable of active transport that can be demonstrated by serial scintigraphic imaging over time (radionuclide hysterosalpingography; RN-HSG). RN-HSG has been suggested to offer a more functional approach to tubal infertility diagnosis than conventional patency tests. However, before RN-HSG can be recommended as a routine method, its reliability in showing active transport in fertile women must be demonstrated. Therefore we compared RN-HSG in two groups: 38 fertile women before tubal sterilization and 38 women undergoing infertility work-up. Tubal transport demonstrated by RN-HSG was comparably distributed in both groups and classified as bilateral (17 versus 19), unilateral (12 versus 7) or no transport (6 versus 9). In each group three RN-HSG images were not interpretable. There was no association between patency test results and RN-HSG in the two groups. Our data suggest that RN-HSG in its present form does not seem to be a reliable method for infertility work-up. Because RN-HSG and patency tests most probably measure different properties of the genital tract, the phenomenon of active particle transportation should be studied further to enable the development of a reliable tool for the investigation of tubal function.

Developmental steps for radionuclide hysterosalpingography.

The active oviductal transportation capacity was studied in 73 infertile women by the use of a new deposition technique of radioactive particles into the internal cervical os. The main reason for this study was that a previous observation had shown that such a transportation capacity was lacking in 41% of the infertile patients with a normal hysterosalpingogram. The examination was performed in the immediate preovulatory phase, i.e. on days -3 to 0 before the ovulation, as measured by the basal body temperature during two preceding cycles. The deposition of 99mTc-labelled albumin particles of 0.2-1.0 micron at the internal cervical os and the interpretation of the radionuclide images are described in detail. The results show that the bilateral active tubal transportation capacity was present in 42 patients. An impaired transportation capacity was diagnosed in 22 patients. In 9 patients, the particles never reached the uterine cavity, or all activity leaked back to the vagina.

Lumbo-omental shunt for drainage of cerebrospinal fluid--an experimental study in dogs. I. The transport of cerebrospinal fluid from the lumbar subarachnoid space, studied by 169Yb-DTPA and a gamma camera.

Studies using an experimental cerebrospinal fluid (CSF) shunting procedure are presented. By transposing a pedicle graft of the greater omentum to the lumbar subarachnoid space, the CSF absorption of the omentum can be utilized. Monitoring the absorption of intrathecally administration of 169Yb-DTPA by gamma camera sequential pictures 1 to 17 months after the shunt procedure, a rapid transport of radionuclide from the lumbo-omental shunt to the systemic venous blood was demonstrated.

Lumbo-omental shunt for drainage of cerebrospinal fluid--an experimental radionuclide study in dogs. II. Evaluation of transport routes from lumbar subarachnoid space to venous blood.

In a series of dogs, the transport routes of intrathecally administered 99Tcm-DTPA from an omental graft to the venous blood were studied by scintillation probes placed over the portal and external jugular veins and by blood samples from the inferior vena cava. It was found early in the course of investigation that a rich revascularization frequently occurred between the transplanted omentum and the surrounding muscles. In all dogs, the omental graft was divided, in its muscle tunnel about 5 cm outside the dural sac, 13--19 months after the implantation. Even after this a rapid transport to the venous system of radionuclide could be demonstrated. The revascularization of the graft was also studied morphologically in two dogs means of microangiography.

Scintigraphic studies of uterine and placental growth and placental migration during pregnancy.

Placental scintigraphy with 113mIn (Indium) combined with cervical marking with a shielded 57Co (Cobalt) radioactive source was used to study uterine and placental growth in human pregnancy and placental location and migration in a total of 176 patients. Uterine length measurements can be used for selecting growth retarded fetuses. There was an approximately constant ratio between placenta diameter and uterine length (0.68 +/- 0.03). When the placenta was located on the ventral uterine wall, low implantation occurred in 61%. The corresponding figure for low implantation when the placenta was located on the dorsal uterine wall was 30%. The difference was highly significant. Placental migration was studied in 20 patients. Significant migration occurred in 11 cases. The placental margin closest to the internal cervical os migrated outwards about 3 cm on average.

External detection of axoplasmic flow using radionuclides.

In order to investigate the possibilities of studying the axoplasmic flow in vivo by means of radionuclide scanning 75Se-methionine was injected into the L6, L7 or S1 spinal ganglia of cats and the spread of the isotope recorded with a gamma camera. -2. After 4 hours the area of isotope distribution extended 1-2 cm cranially and caudally in the spinal cord and a further movement of 1-2 cm was noted during the following 2-5 days. -3. Scanning of removed specimens of the spinal cord, roots, ganglia and nerves confirmed the intramedullary uptake and in addition revealed an uptake in the dorsal root. Determination of the specific radioactivity showed the presence of the isotope in the ventral root and spinal nerve also, however, sufficient for scintigraphy. -4. Microautoradiographic studies with 3H-methionine demonstrated isotope uptake in axons of the dorsal roots and root entry zone of the spinal cord. Hence, the spread of the isotope was likely to have occurred by axoplasmic flow. This seems to provide a basis for further in vivo studies of this phenomenon.

Postoperative leg vein thrombosis and pulmonary embolisn after upper abdominal operations. A prospective study with 125I fibrinogentest and pulmonary scintigraphy.

The incidence of postoperative deep venous thrombosis in the lower limbs and of pulmonary embolism has been studied in 49 patients operated upon for gallbladder and gastric diseases. 125I fibrinogen test was performed preoperatively and usually five times postoperatively. Pulmonary scintigraphy was also performed preoperatively and usually twice after the operation. An attempt was made to evaluate the prophylactic effect of Dextran 40. Only one patient developed a deep vein thrombosis without clinical signs. Postoperative pulmonary embolism was found in 13 patients, all but one clinically silent. The second postoperative pulmonary scintigraphy showed that the emboli had disappeared or diminished in 6 patients. Because of the low number of patients with deep venous thrombosis the prophylactic effect of Dextran 40 could not be assessed. The present investigation showed that the incidence of deep venous thrombosis in the legs was low after operations in the upper part of the abdomen while the incidence of pulmonary embolism was high. No connection between leg vein thrombosis and pulmonary embolism could be demonstrated.

Scintigraphic examination of aneurysms of abdominal aorta and iliac arteries.

The use of a radionuclide (99Tcm-pertechnetate) for the diagnosis of aortic and iliac aneurysms is described. The method is rapid, harmless for the patient and is performed without puncture of arteries. The extent of the aneurysm and the perfusion of the kidneys can be visualized. The method is well suited for differential diagnosis and for postoperative control. Some illustrative cases are described.