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Metrosalpingography (hysterosalpingography)
Last reviewed: 06.07.2025
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A special technique called metrosalpingography is used to examine the uterine cavity and fallopian tubes. Metrosalpingography (hysterosalpingography) is an X-ray performed after filling the uterine cavity and tubes with a contrast agent through the cervical canal. This examination is safe and painless, but it must be performed under aseptic conditions to avoid introducing infection into the abdominal cavity.
[ Methodology and types
On the metrosalpingogram, the shadow of the uterine cavity looks like a triangle with slightly concave sides. Narrow shadows of the uterine (fallopian) tubes begin from the proximal angles of the triangle. The beginning of each tube is marked by a circular narrowing, then the lumen of the tube expands conically - this is its interstitial part. Next comes the straight or slightly tortuous isthmic part measuring 0.5-1.0 mm. Without sharp boundaries, it passes into the ampullar part, which has the largest diameter at the outer end facing downwards. If the tubes are passable, the contrast agent fills them along their entire length, and then is found in the abdominal cavity in the form of separate accumulations.
A kind of analogue of X-ray metrosalpingography is a radionuclide examination of the uterine cavity and tubes - radionuclide metrosalpingography. 1 ml of RFP is injected into the uterine cavity. A clamp is applied to the cervix and the patient is left in a supine position for 30 minutes. Then a scintigram is produced, which produces an image of the uterine cavity and tubes. Normally, the drug is distributed evenly in them and completely passes into the abdominal cavity within 2 hours. However, a radionuclide study serves not so much to study the morphology of the organ as to assess its function - the patency of the tubes.
Radiographs can be used to obtain an image of the vascular system of the uterus and other pelvic organs. Various methods of X-ray contrasting of the arteries and veins of the uterus and pelvic region, as well as examination of the lymphatic vessels and nodes of the pelvis, have been developed for this purpose. These methods are used mainly in the diagnosis of malignant tumors of the uterus and appendages.
An image of a woman's internal genital organs can be obtained using various radiation methods. Ultrasound scanning (sonography) has acquired the most importance among them. It has no contraindications and can be performed in all phases of the menstrual cycle and at any period of pregnancy. The combination of transvaginal and abdominal sonography is especially valuable.
Ultrasound examination allows obtaining an image of the uterus and appendages, assessing their position, shape and size. No special preparation for sonography is required. It is recommended to drink 2-3 glasses of water in the morning before the examination and hold urination. A full bladder provides better visualization of the internal genital organs. The ultrasound sensor is moved in two directions: longitudinal and transverse, obtaining longitudinal and transverse sonograms, respectively.
Sonograms of the pelvis of a healthy woman show the uterus with appendages, vagina, bladder, and rectum. The vagina forms a tubular structure in the form of a dense echogenic strip. The cervix lies along the midline, and its body is usually slightly deviated to the right or left. The contours of the uterus are smooth, its walls give a homogeneous image. In the vast majority of subjects, the uterine cavity is distinguishable. The endometrium causes a thin echogenic strip in the early proliferative phase, but by the end of the secretory phase it thickens to 0.4-0.7 cm.
After determining the position and shape of the uterus, its length, as well as its anteroposterior and transverse dimensions, are calculated. The length of the uterine body is the distance between the internal os of the cervix and the fundus; in women of reproductive age, it is 6-8 cm. The anteroposterior and transverse dimensions are the distances between the two most distant points on the anterior and posterior surfaces of the uterus and between the most distant points on the lateral surfaces. These dimensions vary from 3.5 to 4.5 and from 4.5 to 6.5 cm, respectively. In women who have given birth, the uterus is larger than in women who have not given birth. They decrease during menopause.
The tubes and the broad uterine ligament are not visible on sonograms, and the ovaries look like oval or round formations located near the uterus. Their size varies significantly. Each ovary can be distinguished by a capsule, cortex, and medulla. It is generally accepted that normal ovaries do not exceed 0.5 the size of the uterus. During the menstrual cycle, one of the ovaries progressively increases in size due to the formation of a follicle in it - a hypoechoic formation with a thin wall. Its diameter increases daily by 0.2-0.4 cm, reaching 2.5-3 cm immediately before ovulation.
Thus, sonography, as well as radioimmunological determination of the concentration of lutropin in the blood of a woman, allows us to accurately determine the time of ovulation and the formation of the corpus luteum. These possibilities are used in gynecology to establish the functional completeness of the menstrual cycle.
On conventional radiographs, the uterus and appendages do not produce an image. They can only show the contraceptive device inserted into the uterine cavity, since most of these devices are made of radiopaque materials. Computer or magnetic resonance tomograms are a different matter. The fundus, body and cervix of the uterus, vagina, urinary bladder and ureters, rectum, fatty tissue and pelvic muscles, as well as pelvic bones are successively drawn on different "sections". The ovaries are not always distinguishable, since they are difficult to differentiate from the intestinal loops filled with contents.
Complications during metrosalpingography
If the correct technique is followed, this procedure is not accompanied by side effects. If the technique is violated, complications are possible: exacerbation of infection, bleeding, perforation of the uterine wall, transition of the contrast agent from the uterine cavity to the venous or lymphatic vessels.