Ahmed SA, Taleb HA (2019) Diagnostic Efficiency and Reproducibility of Hysterosalpingography. Int J Radiol Imaging Technol 5:051.


© 2019 Ahmed SA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

ORIGINAL ARTICLE | OPEN ACCESS DOI: 10.23937/2572-3235.1510051

Diagnostic Efficiency and Reproducibility of Hysterosalpingography

Shimaa Abdalla Ahmed1* and Hesham Abo Taleb2

1South Egypt Cancer Institute, Assiut University, Egypt

2Women Health Hospital, Assiut University, Egypt



To evaluate the accuracy of HSG compared to hysteroscopy and or laparoscopy and compare intra and interobserver variability.


200 infertile females underwent hysterosalpingography, hysteroscopy and/or laparoscopy as part of an infertility work up. HSG examinations were retrospectively reviewed by three radiologists, we compared inter-observer variability, differences between the two results of reading the same examination after three months were compared to calculate intra-observer variability.

Final diagnosis was compared to hysteroscopy and/or laparoscopy. The overall sensitivity, specificity, PPV, NPV and accuracy of each HSG diagnosis was assessed.


Intra-observer reliability was variable: observer 1 (k = 0.21; observer 2 (k = 0.57); observer 3 (k = 0.65). Highest agreement was seen in the detection of a normal uterus, normal tubes and uterine filling defect, lowest agreement seen in the detection of uterine and pelvic adhesions.

First round results showed moderate agreement between the three pairs of radiologists (k = 0.53-0.42), second round results showed the substantial agreement of observer 1 (k = 0.62), moderate agreement was seen between radiologist 2 and 3 (k = 0.44).

With consensus diagnosis of all readers combined, HSG overall accuracy in tubal pathology and uterine cavitary lesions diagnosis was 93%, and 85%, respectively. Lowest accuracy was seen in uterine adhesions 71%.


HSG is more accurate in tubal evaluation than the uterine cavity assessment. HSG interpretation is somewhat subjective, although experience and training may improve reporting skills and interpretation results, however, considerable observer variability exists. The gynecologist should carefully interpret HSG results and provide future management based on comprehensive clinical and radiological data.