Title: Mullerian Duct Anomalies: Diagnostic Impact of Magnetic Resonance Imaging
Authors: Ola Mohamed Darwish, Alaa Eldin Mohamed Mustafa
DOI: https://dx.doi.org/10.18535/jmscr/v6i1.02
Abstract
Aim: The aim of the present work is to evaluate the value of magnetic resonance imaging (MRI) in assessment of Mullerian duct anomalies.
Patients and Methods: The study was performed on 20 female patients having clinical gynecological complains and US imaging findings suggestive of having mullerian duct anomalies. All of them undergone clinical assessment, pelvic ultrasound, hysterosalpingography and non-contrast MRI of the pelvis.
Results: The study included 4 uterine agenesis, 2 uterine hypoplasia, 2 bicornuate uteri, 2 unicornuate uteri, 4 septate uteri, 4 uterine didelphys (associated with hemivaginal septum), 1 arcuate uterus and 1 with isolated complete vaginal septum. The circumstances leading to the diagnosis were 1ry amenorrhea (25%), 1ry infertility (15%), dysmenorrhea (15%), recurrent abortion (15%), menstrual irregularity (10%), cyclic pelvic pain (5%) while 15 % were incidentally noted. US was done for all cases. It correctly diagnosed absent uterus in 4 cases with uterine agenesis and bicornuate uterus (in 2 cases). it incorrectly diagnosed the cases of uterine didelphys (4 cases) as bicornuate uterus. It missed the diagnosis of uterine hypoplasia, unicornuate uterus, septate uterus, arcuate uterus and vaginal septum. HSG was done for 10 cases. It correctly diagnosed a patient with unicornuate, 2 patients with bicornuate uterus & patient with arcuate uterus. It misdiagnosed the cases of uterine didelphys as unicornuate uterus and the cases of septate uterus as bicornuate uterus. MRI was done for all cases. It succeeded to identify all patients with MDAs with proper specification of its types showing100% diagnostic accuracy.
Conclusion: Hystrosalpingography proved to be not suitable for complete assessment of MDAs. It couldn’t be done to females with vaginal agenesis, vaginal septum and in patients with genital infection. Ultrasonography has limited capability in detection of double uterus, and cervical and vaginal anomalies. Not only MRI is sensitive in diagnosis of MDAs but also very accurate in MDAs specification. MRI is capable of detecting associated renal system anomalies.
Keywords: Mullerian duct anomalies ( MDAs), MRI , HSG and ultrasound.
References
- Behr SC, Courtier JL, Qayyum A. Imaging of Müllerian Duct Anomalies. Radiographics 2012; 32(6):233-50.
- Gouhar GK, Siam S. Uterine septum structure and reproductive performance: Role of 3D TVUS and MRI. Egyptian J Radiol Nuclear Med 2013; 44, 357–365
- Epelman M, Dinan D, Gee MS et-al. Mullerian duct and related anomalies in children and adolescents. MagnReson Imaging Clin N Am 21 (2013) 773–789.
- Junqueira BL, Allen LM, Spitzer RF et-al. Müllerian Duct Anomalies and Mimics in Children and Adolescents: Correlative Intraoperative Assessment with Clinical Imaging1. Radiographics 2009; 29(4):1085-103.
- Olpin JD, Heilbrun M. Imaging of Müllerian duct anomalies. Topics in Magnetic Resonance Imaging 2010; 21(4):225.
- Deutch TD, Abuhamad AZ. The Role of 3-Dimensional Ultrasonography and Magnetic Resonance Imaging in the Diagnosis of Müllerian Duct Anomalies A Review of the Literature. Journal of Ultrasound in Medicine 2008; 27(3):413-23.
- Shulman Leep. Mullerian anomalies. Clinical obstetrics and gynecology 2008; 51(2):214-22.
- Mazouni C, Girard G, Deter R et-al. Diagnosis of Mullerian anomalies in adults: evaluation of practice. Fertility and sterility 2008; 89(1):219-22.
- Edmonds DK. Rokitansky syndrome and other Mullerian anomalies. In: Balen AH, Creighton SM, Davies MC, MacDougall J, Stanhope R, eds. Paediatric and adolescent gynaecology. Cambridge, England: Cambridge University Press, 2004; 267–274.
- The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, müllerian anomalies and intrauterine adhesions. FertilSteril 1988;49(6):944–955.
- Troiano RN, McCarthy SM. Müllerian duct anomalies: imaging and clinical issues. Radiology 2004; 233(1):19–34.
- Reuter K, Daly Dand Cohen S: Septate versus bicornuate uteri: errors in imaging diagnosis. Radiology 1998:172:749-752.
- Buttram VC, Gibbons WE. Müllerian anomalies: a proposed classification. (An analysis of 144 cases). Fertil. Steril. 1979;32 (1): 40-6.
- Carrington BM, Hricak H, Nuruddin RN et-al. Mullerian duct anomalies: MR imaging evaluation. Radiology. 1990;176 (3): 715-