title: Essure microinsert imaging: does abnormal shape on ultrasound predict complications on HSG?
abstract: We hypothesize that the shape of the Essure microinsert on ultrasound is able to predict complications evident on hysterosalpingogram (HSG), the accepted gold standard.
  
  
  
  From July 2, 2009 to July 2, 2012, 441 women at our institution received Essure microinsert placement for the purpose of permanent sterilization. 2D and 3D coronal plane transvaginal ultrasounds were performed three months after Essure microinsert placement. Those patients with complications identified on ultrasound, a non-diagnostic ultrasound, or following a difficult insertion were referred for HSG. Patients with both HSG and ultrasound performed were retrospectively selected and anonymized. The ultrasounds were reviewed by a single, blinded radiologist. A total of 122 microinserts in 65 patients were described on ultrasound using a numeric grading system and compared to HSG findings.
  
  
  
  Microinsert placement resulted in 37 complications, 31 of which were identified on ultrasound, including uterine and tubal perforations and placement in the endometrial cavity. The sensitivity of Essure microinsert shape on ultrasound in predicting complications, compared with standard HSG, was 94%, with a positive predictive value of 85%; specificity was 95%, with a negative predictive value of 98%. The Kappa coefficient was 0.85 (p < 0.001).
  
  
  
  Our results suggest that ultrasound may be used as a frontline imaging modality for patients after Essure microinsert placement.
authors.affiliation: Department of Medical Imaging, Royal University Hospital, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada. mceachern.wendaline@mayo.edu.|Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA. mceachern.wendaline@mayo.edu.
authors.forename: Wendaline M
authors.initials: WM
authors.lastname: VanBuren
authors.affiliation: Department of Medical Imaging, Royal University Hospital, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada.|Radiology Associates of Regina, University of Saskatchewan, 2727 Parliament Avenue, Regina, SK, S4S 3R1, Canada.
authors.forename: Ian B
authors.initials: IB
authors.lastname: Suchet
authors.affiliation: Gynecology and Reproductive Sciences, Regina General Hospital, University of Saskatchewan, 100-2631 28th Avenue, Regina, SK, S4S 6X3, Canada.
authors.forename: John A
authors.initials: JA
authors.lastname: Thiel
authors.affiliation: Regina Qu'Appelle Health Region, 2180 - 23rd Avenue, Regina, SK, S4S 0A5, Canada.
authors.forename: Erwin
authors.initials: E
authors.lastname: Karreman
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007047:Hysterosalpingography / Q000379:methods*; D021621:Imaging, Three-Dimensional; D007434:Intrauterine Devices / Q000009:adverse effects*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013246:Sterilization, Tubal / Q000295:instrumentation*; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods*
keywords: Essure; Fallopian tube; Hysterosalpingogram; Infertility; Tubal occulsion; Uterus