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BACKGROUND: To evaluate SONAZOID real-time four-dimensional hysterosalpingography (4D-HyCoSy) for assessing fallopian tube patency in endometriosis (EM)-induced infertility. METHODS: A retrospective study of 100 patients (200 fallopian tubes) underwent SONAZOID 4D-HyCoSy. Patients were divided into six groups based on varying degrees of tubal patency or obstruction. A liquid injection machine was employed to record the peak pressure for contrast agent injection, and the corresponding pain score of the patients was noted. Contrast agent reflux and quantitative range were observed in each group. Hysteroscopy combined with laparoscopy was considered the gold standard. RESULTS: The diagnostic accuracy of 4D-HyCoSy was 95.23% (20/21) compared to laparoscopy. Peak pressure and pain scores were significantly higher in patients with bilateral obstruction than in the other groups (p < 0.05). Effect sizes for significant comparisons were predominantly large (Hedges' g > 0.8), indicating clinically meaningful differences. CONCLUSION: 4D-HyCoSy, combined with quantitative indicators like intrauterine peak pressure, pain score, and contrast reflux, provides an effective and objective assessment of tubal patency in EM-induced infertility, thereby offering a valuable imaging reference for clinical evaluation of tubal status.
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Mao et al. (2026) studied this question.