What question did this study set out to answer?

The aim is to evaluate tubal patency and fimbrial function noninvasively using multimodal hysterosalpingography.

April 6, 2026Open Access

Multimodal Hysterosalpingography for One-Stop Assessment of Tubal Patency and Fimbrial Function: A Prospective Diagnostic Trial

LXLijun XieFujian Medical University LHLiyan HuangFujian Medical University HLHaiying LiFujian Medical University

Key Points

The aim is to evaluate tubal patency and fimbrial function noninvasively using multimodal hysterosalpingography.
Conducted a prospective study with 136 infertile patients.
Implemented multimodal hysterosalpingography combining 4D ultrasound, 2D color Doppler imaging, and saline-infused scanning.
Compared diagnostic performance against the gold-standard laparoscopic dye test (LDT).
Analyzed correlations between fimbrial morphology and tubal function.
Achieved sensitivity of 93.94% for patency, 85.29% for partial obstruction, and 90.7% for total obstruction.
Specificity reached 97.49%, outperforming single-modality examinations.
Visualization of fimbrial structures improved detection rates significantly from 34.7% to 62.1%.
Abnormal fimbrial morphology correlated with tubal dysfunction, rising from 16.9% to 95.1% based on obstruction status.
Concordance with LDT was 88.6%, with sensitivity of 92.9% and specificity of 94.4%.

Abstract

Background: Tubal infertility is a major cause of female infertility, necessitating accurate evaluation of fallopian tube patency and fimbrial function. While a laparoscopic dye test (LDT) remains the gold standard, its invasiveness limits clinical use. This study proposes a multimodal hysterosalpingography approach combining four-dimensional (4D) contrast-enhanced ultrasound (4D HyCoSy), two-dimensional color Doppler imaging (2D-CIS), and 2D baseline scanning with saline-infused uterine cavity contrast (2D-FS + SIPS) for noninvasive, comprehensive tubal assessment. Methods: A prospective study included 136 infertile patients (242 fallopian tubes) from March 2022 to August 2025. All patients underwent multimodal hysterosalpingography. Diagnostic performance was compared against LDT, and correlations between fimbrial morphology and tubal function were analyzed. Results: Multimodal integration significantly improved diagnostic accuracy: sensitivity for patency, partial obstruction, and total obstruction was 93.94%, 85.29%, and 90.7%, respectively, with a specificity of 97.49%, outperforming single-modality examinations ( p < 0.05). The addition of 2D-FS + SIPS enhanced visualization of fimbrial structures, increasing detection rates from 34.7% to 62.1% ( p < 0.001). Abnormal fimbrial morphology strongly correlated with tubal dysfunction, with abnormality rates rising from 16.9% (patent) to 61.1% (partially obstructed) and 95.1% (obstructed) ( p < 0.001). Multimodal evaluation showed 88.6% concordance with LDT (kappa = 0.765), sensitivity of 92.9%, and specificity of 94.4%. Conclusion: Multimodal hysterosalpingography provides a noninvasive, one-stop solution for precise evaluation of tubal patency and fimbrial function. It identifies fimbrial pathology as a key factor in distal tubal obstruction, offering valuable insights for etiology diagnosis and personalized treatment of tubal infertility.

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