Comparison of Image Quality and Safety Profile between Ethiodol and Ioversol Contrast Medium for Hysterosalpingography: A Meta-Analysis

The selection of an hysterosalpingography (HSG) contrast medium is quite essential due to the different imaging performances and safety profiles among contrast medium during the HSG procedure. Ethiodol and ioversol are the most common contrast mediums, whose superiority of imaging performance and safety profile during HSG is controversial. This meta-analysis aimed to comprehensively compare image quality and safety between infertility patients who received HSG with ethiodol and ioversol. PubMed, Web of Science (WOS), Google Scholar, China National Knowledge Infrastructure (CNKI), Wanfang, and Chongqing VIP (CQVIP) were utilized for literature searching until September 1, 2023. Twelve cohort studies containing 3,622 patients who underwent HSG with ioversol (N = 1,693) or ethiodol (N = 1,929) were included. Ethiodol realized an elevated rate of good and excellent image quality compared to ioversol (risk ratio (RR) = 0.94, 95% confidence intervals (CI): 0.89-1.00, P = 0.035). Whereas the incidence of overall adverse events (AEs) was reduced in patients receiving HSG with ioversol than ethiodol (RR = 0.53, 95% CI: 0.32-0.86, P = 0.011). Nevertheless, incidences of each adverse event, including reflux of contrast medium, abdominal pain, nausea and vomiting, and cough, were not different between patients receiving HSG with ioversol and ethiodol (all P > 0.050). The risk of bias was low, and there was no evidence of publication bias. Meanwhile, sensitivity analysis revealed that the result of image quality was affected by omitting some studies, but most other results were robust. Conclusively, ethiodol realizes improved image quality but ioversol realizes fewer overall AEs for HSG in infertility patients, suggesting that their clinical selection can refer to actual demands.