Indications, Performance, and Limitations of Saline Infusion Sonography (Sonohysterography)
Primary Clinical Indications
- SIS is indicated when transvaginal ultrasound reveals abnormal or equivocal endometrial cavity findings, especially to evaluate intra‑uterine adhesions, endometrial polyps, and submucosal leiomyomas in patients with infertility or abnormal uterine bleeding. 1
- In infertility work‑up, SIS is useful for detecting intra‑uterine adhesions, polyps, and leiomyomas that may compromise the uterine cavity. 4
- The American College of Radiology recommends SIS for assessing uterine cavity abnormalities during infertility evaluation because it provides superior visualization compared with transvaginal ultrasound alone. 4
Diagnostic Accuracy
- Sensitivity 75 % and specificity 93 % for detecting intra‑uterine adhesions, markedly higher than transvaginal ultrasound. 4
- For submucosal fibroid assessment, SIS accurately quantifies the intracavitary component, directly influencing treatment planning. 7
- Three‑dimensional SIS demonstrates good agreement with diagnostic hysteroscopy for classifying submucosal fibroids (kappa = 0.80). 7
- Three‑dimensional SIS improves classification of uterine anomalies and delineation of endometrial versus myometrial lesions. 4
Situations Where SIS Is Not Indicated
- There is no supporting literature for using isolated SIS in suspected endometriosis; alternative imaging (transvaginal ultrasound, MRI, or trans‑rectal ultrasound) should be employed. 8
- Isolated SIS without a tubal contrast agent is not appropriate for evaluating tubal occlusion; hysterosalpingo‑contrast sonography (HyCoSy) with echogenic contrast is required for tubal patency assessment. 9
Procedural Considerations
- Antibiotic prophylaxis is left to the discretion of the referring physician when the patient has a prior history of pelvic inflammatory disease or hydrosalpinx identified at the time of the study. 8
Recommendations for Clinical Workflow
- Proceed to SIS after an initial transvaginal ultrasound when:
- Consider three‑dimensional SIS when detailed classification of uterine anomalies or precise measurement of intracavitary fibroid components is required. 4
Strength of evidence: All cited data are derived from peer‑reviewed studies published in the Journal of the American College of Radiology; specific evidence grades were not provided in the source material.