Fallopian tube disease: the cobblestone pattern as a radiographic sign.
OBJECTIVE
To identify radiographic signs of mucosal damage by comparing hysterosalpingography with salpingoscopy in a prospective study.


METHODS
Forty-one candidates for laparoscopy underwent hysterosalpingography and peroperative salpingoscopy; at both, tubal patency was noted. Radiographic criteria for mucosal abnormality were rounded filling defects (ie, the cobblestone pattern) and the absence of longitudinal radiolucent bands in the ampullary tract. At salpingoscopy, tubal mucosa was categorized by means of inspection into five classes of fold pattern: classes I and II, normal; classes III-V, abnormal. Hysterosalpingographic and salpingoscopic results were compared by means of a two-by-two table and kappa statistics.


RESULTS
Seventy-four tubes were evaluated. At hysterosalpingography, 31 tubes were distally nonpatent. Of these, 26 showed a distal obstruction at salpingoscopy. None of the patent tubes at hysterosalpingography showed obstruction at salpingoscopy. The agreement between hysterosalpingography and salpingoscopy in detecting abnormal mucosal pattern was 89.2% (kappa, 0.73; P: <.001). The cobblestone pattern always corresponded to intraluminal adhesions at salpingoscopy. The absence of radiolucent bands corresponded to abnormal mucosa at salpingoscopy in four of six cases. The cobblestone pattern was found only in hydrosalpinges and never in patent tubes. Six normal patent tubes at hysterosalpingography showed intraluminal adhesions at salpingoscopy.


CONCLUSIONS
Results indicate that the cobblestone pattern is an effective radiographic sign of intraluminal adhesions in hydrosalpinges and suggest that intraluminal disease in patent tubes might not always be excluded on normal hysterosalpingograms.
Valentini
A L
AL
Department of Radiology , , Universita' Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy. md7368@mclink.it
Muzii
L
L
Marana
R
R
Catalano
G F
GF
Felici
F
F
Destito
C
C
Marano
P
P
D000328:Adult; D005184:Fallopian Tube Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging*; D005187:Fallopian Tubes / Q000473:pathology; D005260:Female; D006801:Humans; D007047:Hysterosalpingography; D010535:Laparoscopy; D009092:Mucous Membrane / Q000000981:diagnostic imaging / Q000473:pathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D000267:Tissue Adhesions / Q000000981:diagnostic imaging