Imaging techniques for fallopian tubes

MR is an assistive imaging technique, helpful for the diagnosis of tubal diseases and deep infiltrating endometriosis.

Key Points

Importance:

• Endometriosis may involve Fallopian tubes.
• The anatomy of fallopian tubes and related diseases which range from congenital, and benign to malign diseases are essential for radiologists.

Highlights:

• MR imaging provides a non-invasive assessment of all tubal diseases and deeply invaded endometriosis.
• Infertility caused by tubal obstructions and peritubular adhesions is important and could be diagnosed through imaging techniques.

What's done here:

• The anatomy, embryology, physiology, and benign or malign diseases with related imaging techniques of the fallopian tubes are summarized.
• The authors sought to provide a guideline for radiologists regarding potential difficulties in imaging the tuba uterinae.

Outlines:

• Endometriosis and pelvic inflammatory disease are the most common disorders affecting the Fallopian tubes. Careful evaluation of fallopian tubes should be performed in every woman with pelvic pain.
• A complex multiloculated pelvic mass necessitates isolating the ovary from distended ampullary segments and fimbriae.
• The presence of hematosalpinx with a positive pregnancy test is highly suspicious for ectopic pregnancy; even an extrauterine gestational sac is not identified.
• Extraluminal and intraluminal endometriosis are two recognized forms of tubal deep endometriosis:
  • In extraluminal tubal endometriosis, the serosal implants cause hemorrhage and fibrosis repeatedly, leading to peritubal adhesions and hydrosalpinx.
  • Intraluminal tubal endometriosis is less common, occurring in the tubal wall.
  • Bleeding into the lumen from these tubal implants can lead to hematosalpinx, which may be the only MR imaging finding of deep endometriosis.
  • Malignant transformation of endometriosis is a rare complication and should be considered when thickened septa or enhancing nodules are seen in the hematosalpinx
• Distinguishing ovarian cysts from para-tubal cysts is another important feature of radiologic identification. 

Lay Summary

The imaging techniques used for suspected fallopian tube pathology are ultrasound, hysterosalpingo-contrast-sonography, hysterosalpingography, computed tomography, and magnetic resonance imaging.

Among several benign lesions that involve fallopian tubes, pelvic inflammatory disease, tubo-ovarian abscess, salpingitis isthmica nodosa, hydrosalpinx, tubal endometriosis, isolated fallopian tube torsion, ectopic pregnancy, and benign neoplasms of tuba uterina. On the other hand, primary fallopian tube carcinoma and serous tubal intraepithelial carcinoma are their malign neoplasms. Some pathologies as peritoneal inclusion cysts, lymphocele, and acute appendicitis, mimic fallopian tube diseases.

In order to make the differential diagnosis of all these diseases, radiologists must be skilled in evaluating clinical and imaging findings of fallopian tubes to conclude. Familiarity with fallopian tube anatomy, embryology, diseases, and imaging features of these conditions is crucial for radiologists to make an accurate diagnosis. 

Khine et al. from the Department of Radiology and Biomedical İmaging of the University of California, San Francisco, USA, penned this paper to provide convenience for radiologists while evaluating diseases and disorders of fallopian tubes by imaging techniques in the January 2023 issue of the medical journal named "Magnetic Resonance Imaging Clinics of North America". 

The information about endometriosis involving ovaries is as follows: Two recognized forms of tubal deep endometriosis are extraluminal and intraluminal endometriosis. In extraluminal tubal endometriosis, the serosal implants repeatedly cause hemorrhage and fibrosis leading to tubal adhesions and hydrosalpinx. Intraluminal tubal endometriosis is less common, occurring in the muscles of the tubal wall. These tubal implants cause bleeding into the lumen and can lead to hematosalpinx, which may be the only MR imaging finding of deep endometriosis. Although a rare complication, malignant transformation of endometriosis should be considered when thickened septa or enhancing nodules are seen in the hematosalpinx.

Research Source: https://pubmed.ncbi.nlm.nih.gov/36368860/