title: Power Doppler flow mapping and four-dimensional ultrasound for evaluating tubal patency compared with laparoscopy.
abstract: OBJECTIVE
  To study the accuracy of four-dimensional (4D) ultrasound and power Doppler flow mapping in detecting tubal patency in women with sub-/infertility, and compare it with laparoscopy and chromopertubation.
  
  
  METHODS
  A prospective study. The study was performed in the outpatient clinic and infertility unit of a university hospital. The sonographic team and laparoscopic team were blinded to the results of each other. Women aged younger than 43 years seeking medical advice due to primary or secondary infertility and who planned to have a diagnostic laparoscopy performed, were recruited to the study after signing an informed consent. All of the recruited patients had power Doppler flow mapping and 4D hysterosalpingo-sonography by injecting sterile saline into the fallopian tubes 1 day before surgery. Registering Doppler signals, while using power Doppler, both at the tubal ostia and fimbrial end and the ability to demonstrate the course of the tube especially the isthmus and fimbrial end, while using 4D mode, was considered a patent tube.
  
  
  RESULTS
  Out of 50 recruited patients, 33 women had bilateral patent tubes and five had unilateral patent tubes as shown by chromopertubation during diagnostic laparoscopy. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for two-dimensional power Doppler hysterosalpingography were 94.4%, 100%, 100%, 89.2%, and 96.2%, respectively and for 4D ultrasound were 70.4%, 100%, 100%, 70.4%, and 82.6%, respectively.
  
  
  CONCLUSIONS
  Four-dimensional saline hysterosalpingography has acceptable accuracy in detecting tubal patency, but is surpassed by power Doppler saline hysterosalpingography. Power Doppler saline hysterosalpingography could be incorporated into the routine sub-/infertility workup.
authors.affiliation: University of Alexandria, Department of Obstetrics and Gynecology, El Shatby Maternity University Hospital, Port-Said Street, 21526 El-Shatby, Alexandria, Egypt; Carl von Ossietzky University Oldenburg, Department of Obstetrics and Gynecology, Oldenburg University Women's Hospital, Rahel-Straus-Straße 10, 26133 Oldenburg, Germany. Electronic address: soliman.amr@klinikum-oldenburg.de.
authors.forename: Amr A
authors.initials: AA
authors.lastname: Soliman
authors.affiliation: University of Alexandria, Department of Obstetrics and Gynecology, El Shatby Maternity University Hospital, Port-Said Street, 21526 El-Shatby, Alexandria, Egypt.
authors.forename: Waleed
authors.initials: W
authors.lastname: Shaalan
authors.affiliation: University of Alexandria, Department of Obstetrics and Gynecology, El Shatby Maternity University Hospital, Port-Said Street, 21526 El-Shatby, Alexandria, Egypt.
authors.forename: Tamer
authors.initials: T
authors.lastname: Abdel-Dayem
authors.affiliation: University of Alexandria, Department of Obstetrics and Gynecology, El Shatby Maternity University Hospital, Port-Said Street, 21526 El-Shatby, Alexandria, Egypt.
authors.forename: Elsayed Elbadawy
authors.initials: EE
authors.lastname: Awad
authors.affiliation: University of Alexandria, Department of Obstetrics and Gynecology, El Shatby Maternity University Hospital, Port-Said Street, 21526 El-Shatby, Alexandria, Egypt.
authors.forename: Yasser
authors.initials: Y
authors.lastname: Elkassar
authors.affiliation: Carl von Ossietzky University Oldenburg, Department of Obstetrics and Gynecology, Oldenburg University Women's Hospital, Rahel-Straus-Straße 10, 26133 Oldenburg, Germany.
authors.forename: Dörte
authors.initials: D
authors.lastname: Lüdders
authors.affiliation: Carl von Ossietzky University Oldenburg, Department of Obstetrics and Gynecology, Oldenburg University Women's Hospital, Rahel-Straus-Straße 10, 26133 Oldenburg, Germany.
authors.forename: Eduard
authors.initials: E
authors.lastname: Malik
authors.affiliation: University of Alexandria, Department of Obstetrics and Gynecology, El Shatby Maternity University Hospital, Port-Said Street, 21526 El-Shatby, Alexandria, Egypt.
authors.forename: Hassan N
authors.initials: HN
authors.lastname: Sallam
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005184:Fallopian Tube Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging*; D005187:Fallopian Tubes / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007047:Hysterosalpingography; D007247:Infertility, Female / Q000175:diagnosis / Q000000981:diagnostic imaging*; D010535:Laparoscopy / Q000379:methods; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D018608:Ultrasonography, Doppler / Q000379:methods*
keywords: Power Doppler; Saline hysterosalpingography; Tubal factor infertility; Tubal patency