What are the differences between ultrasound contrast imaging and hysterosalpingography?

Generally, contrast-enhanced ultrasound (CEUS) and hysterosalpingography (HSG) are common gynecological examination methods. Their main differences lie in the principles of imaging, applicable populations, diagnostic accuracy, procedural comfort, and post-procedure care. The detailed analysis is as follows:

1. Imaging Principles: Contrast-enhanced ultrasound involves injecting an ultrasound contrast agent through the vagina or abdomen. The agent enhances ultrasound signals, allowing clear visualization of the uterus, fallopian tubes, and pelvic structures. Hysterosalpingography, on the other hand, involves inserting a catheter into the uterine cavity to inject a radiographic contrast agent, followed by X-ray fluoroscopy or CT imaging to observe the flow path of the contrast and assess tubal patency.

2. Applicable Populations: CEUS is radiation-free, making it suitable for women planning pregnancy and those sensitive to X-rays; it may be cautiously used during pregnancy if necessary. Due to its use of X-ray radiation, HSG requires women planning pregnancy to wait at least three months after the procedure before conceiving. It is more appropriate for patients needing precise evaluation of the location and severity of tubal blockage.

3. Diagnostic Accuracy: CEUS allows real-time dynamic observation and clearly shows the morphology of the fallopian tubes and any pelvic adhesions, though it is slightly less sensitive in detecting minor tubal obstructions. HSG is more accurate in pinpointing the exact site and degree of tubal blockage and can also clearly reveal abnormalities in uterine cavity morphology.

4. Procedural Comfort: CEUS is quicker and uses a contrast agent with minimal irritation; most individuals experience only mild abdominal bloating. HSG involves catheter insertion and contrast injection, which may cause significant abdominal pain. Additionally, patients must maintain a fixed position during X-ray exposure, resulting in lower overall comfort.

5. Post-Procedure Care: After CEUS, patients should avoid sitz baths for 24 hours but do not need to deliberately avoid pregnancy. After HSG, patients must refrain from sitz baths and sexual intercourse for two weeks, take antibiotics as prescribed to prevent infection, and strictly avoid pregnancy to minimize potential radiation effects on a developing embryo.

Both procedures have their advantages. Physicians will make comprehensive recommendations based on the patient’s clinical needs and health status. Patients should discuss their individual circumstances thoroughly with their doctor to choose the most appropriate examination method.