OBJECTIVE. Our purpose was to compare hysterosalpingography with laparoscopy in
the diagnosis of peritubal adhesions and to verify whether a combination of radiographic
signs improves hysterosalpingographic accuracy.
SUBJECTS AND METHODS. Thirty candidates for laparoscopy underwent hysterosalpingography
before surgery. Two radiologists evaluated the presence or absence and types of
radiographic signs of peritubal adhesions (convoluted tubes, vertical tubes, loculation of contrast
medium in peritoneum, halo effect, and fixed laterodeviation of the uterus) using two different
criteria for normality or abnormality: no sign means a normal result, one or more signs
mean an abnormal result (first criterion); no sign or one sign means a normal result, two or
more signs mean an abnormal result (second criterion). Interpretation discrepancies were resolved
by consensus. Peritubal and periovarian adhesions were evaluated by a single operating
surgeon during laparoscopy (recorded on S-VHS videotape) and by a different surgeon
reviewing the videotape. The radiographic results obtained using the two criteria in radiologically
patent as well as in distally nonpatent tubes were compared with corresponding laparoscopic
results by 2x 2 tables and were statistically analyzed (kappa statistics).
RESULTS. The first criterion displayed poor diagnostic accuracy. The correlation with
laparoscopy was not statistically significant in either radiologically patent or distally nonpatent
tubes. The second criterion greatly improved the agreement with laparoscopy, but only
in patent tubes (k = 0.7789; p < 0.001).
CONCLUSION. Hysterosalpingographic accuracy in peritubal adhesion diagnosis can be
improved in patent tubes by taking into account more than one of the reported radiographic signs