Intravasation is not only a complication but also a radiological finding for tubal pathologies in hysterosalpingography.

OBJECTIVES

Hysterosalpingography (HSG) remains the first-line imaging technique for assessing fallopian tube conditions due to its accessibility, cost-effectiveness, and high diagnostic accuracy. Intravasation, the leakage of contrast media into myometrial or vascular structures during HSG, has been documented as a complication. This study aimed to determine the prevalence of intravasation, explore the relationship between intravasation and tubal occlusion, and assess the applicability of grading intravasation.

METHODS

A retrospective analysis of 3032 HSG examinations performed between January 2021 and May 2024 was conducted. Intravasation, tubal occlusion, and related findings were recorded using standard X-ray equipment and categorized prospectively. Statistical analysis included logistic regression to identify predictors of tubal occlusion and inter-observer agreement using Fleiss Kappa. Diagnostic metrics for intravasation as a radiological marker of tubal occlusion were calculated.

RESULTS

Intravasation was observed in 2.6% of cases. Among cases with tubal occlusion, 16.4% exhibited intravasation. The sensitivity, specificity, positive predictive value, and negative predictive value of intravasation for detecting tubal occlusion were 14.5%, 99.8%, 92.3%, and 85.6%, respectively. Adjusted odds ratios indicated that intravasation increased the likelihood of tubal occlusion approximately 55-fold. Inter-observer agreement for intravasation detection was almost perfect (Kappa = 0.97). Limitations included the absence of oil-based contrast and a pressure manometer during contrast infusion.

CONCLUSIONS

Intravasation, traditionally viewed as a complication, emerges as a significant radiological indicator of tubal occlusion. Incorporating intravasation characteristics, such as initiation time, into grading systems may enhance diagnostic accuracy. Further refinement of classification systems and broader clinical validation are recommended.

ADVANCES IN KNOWLEDGE: About 92.3% of tubes with intravasation were occluded and the site of intravasation correlated with the occlusion site. Occlusion was 55× more likely in cases with intravasation, traditionally viewed as a complication, emerges as a significant radiological indicator of tubal occlusion.