MR imaging diagnosis of uterovaginal anomalies: current state of the art

[(Uro)genital developmental disorders]

CLINICAL ISSUE

Congenital anomalies of the urogenital tract are common, whereas isolated developmental disorders of the genital organs are rare and varied. The type and timing of imaging to characterize these developmental disorders and the planning of any treatment are the subject of discussion. The aim of this article is to provide a brief overview of embryology, diagnostic procedures, and examples of findings.

STANDARD RADIOLOGICAL METHODS

The primary procedure for imaging the genitals is sonography, which must be performed with appropriate empathy. In addition to the genitals, the general situation of the kidneys and urinary tract should be examined, as urogenital malformations are often combined. Dedicated magnetic resonance imaging (MRI) is indicated as advanced imaging in interdisciplinary consultations. Invasive procedures, such as genitography combined with micturition cystourethrography (MCU) using X‑rays or contrast-enhanced sonography, are rarely required. Computed tomography (CT) or excretory urography play no role.

CONCLUSION

Imaging plays an important role in the assessment of genital anomalies. Knowledge of embryology facilitates anatomical understanding and the assessment of pathologies.

Should we screen for Müllerian anomalies following diagnosis of a congenital renal anomaly?

INTRODUCTION

Despite the well-established embryological relationship in the development of renal and Müllerian structures, no clear guidelines exist regarding screening for Müllerian anomalies (MA) in the setting of a renal anomaly (RA). Delayed diagnosis of MA can have significant reproductive consequences.

OBJECTIVE

To investigate the prevalence of coexisting MA in patients with congenital RA.

STUDY DESIGN

This is a retrospective cohort study of females age 12-35 years with a diagnosis of RA, identified by diagnosis codes, who were followed for care between 2013 and 2020. Data were collected on demographics, medical history, clinical presentation, and imaging studies. Descriptive statistics were used to summarize the data. This study was IRB approved.

RESULTS

A total of 465 patients were included in this study, of whom 326 patients (70.3%) had a pelvic evaluation during the study period. Of these 326 patients, 125 (38.3%) were found to have coexistent MA. About one-third of patients who underwent pelvic evaluation due to pain were found to have MA. For 69.6% (87/125) of patients with MA, the RA was diagnosed prior to the MA. The average age at time of RA diagnosis was 6.4 ± 8.8 years and the average age of MA diagnosis was 16.4 ± 6.9 years. Forty-eight (38.4%) patients had obstructive anomalies. Of the Müllerian obstructions, 93.8% were treated with urgent surgery and the remainder started on hormonal suppression. The prevalence of MA was dependent on the RA diagnosis (Figure). Of patients with a solitary kidney, 67.1% were diagnosed with MA. For other parenchymal RA, the prevalence of MA was 20-23%. In patients with solitary kidney, uterus didelphys was the most common MA (52.1%). Thirty percent of patients with a solitary kidney were diagnosed with an obstructive MA.

CONCLUSIONS

In this study, 38% of patients with RA who underwent a pelvic evaluation were found to also have MA. Our study shows the strongest association between MA and solitary kidney, but also emphasizes a significant risk with other RA. Almost 40% of patients with diagnosed MA were found to have an obstruction that required urgent treatment. Delays in diagnosis and treatment of Müllerian obstructions can be detrimental for future reproductive health, due to risk of chronic pain, infertility, infection, and endometriosis. Given the high prevalence of MA in patients with RA, especially those with congenital solitary kidney, routine screening with pelvic ultrasound should be performed around the age of expected menarche.

Neonatal hydrocolpos presenting as a rapidly progressive abdominal mass with inferior caval vein syndrome

A 7-week-old infant was presented at the emergency department with an abdominal mass, unilateral swelling of the groin and suspicion of an inferior caval vein syndrome with bluish discolouration and oedema of the lower extremities. Abdominal imaging showed two large cysts and profound bilateral hydronephrosis. Following laparotomy, an extreme hydrocolpos and an overdistended urinary bladder were found. These findings turned out to be secondary to a transverse vaginal septum. She was treated surgically and was hospitalised for 2 weeks. Long-term follow-up showed normalisation of previously present hypercalciuria and hydronephrosis.A hydro(metro)colpos should be considered in the differential diagnosis of a female infant presenting with an abdominal mass, to apply the appropriate investigations and therapy.

Hemiuterus with functional non-communicating horn in a young female

Background

Mullerian duct anomalies are a broad spectrum of congenital anomalies of the female genital tract presenting with variable symptoms like infertility, amenorrhoea, dysmenorrhea, pelvic endometriosis, and poor obstetric outcomes. Unicornuate uterus or hemiuterus occurs as a result of abnormal formation or failure of formation of the contralateral part.

Case presentation

We present a rare case report of hemiuterus with functional non-communicating horn along with hematometra in a 15-year-old female who presented with severe dysmenorrhoea since her menarche. Pelvic Ultrasonography demonstrated inconclusive findings of a heterogenous lesion in the right pelvic cavity adjacent to the uterus. Further, pelvic MRI revealed a hemiuterus on the left side with a normal endometrial cavity and a well-defined functional non-communicating horn on right side. The diagnosis of European Society of Human Reproduction (ESHRE) Classification U4a uterine anomaly (left hemiuterus with functional non-communicating horn on right side) was established.

Conclusions

ESHRE Class U4a comprises of hemiuterus with a functional rudimentary horn. This is considered clinically significant as it may lead to further complications, such as hematometra or ectopic pregnancy in the rudimentary horn. Hence, the correct identification of this entity is essential as laparoscopic removal is the current recommended management.

Imaging of the Vagina: Spectrum of Disease with Emphasis on MRI Appearance

The vagina is a median fibromuscular structure of the female reproductive system that extends from the vulva inferiorly to the uterine cervix superiorly. As most vaginal lesions are detected at gynecologic examination, imaging performed for nongynecologic indications can frequently cause concomitant vaginal pathologic conditions to be overlooked. The vagina is often underevaluated at routinely performed pelvic transvaginal US because of a narrow scan area and probe positioning. MRI has progressively become the imaging method of choice for vaginal pathologic conditions, as it provides excellent soft-tissue detail with unparalleled delineation of the complex pelvic floor anatomy and helps establish a diagnosis for most vaginal diseases. It is important that radiologists use a focused approach toward understanding and correctly recognizing different vaginal entities that may otherwise go unnoticed. In this case-based review, the authors discuss the key imaging features of wide-ranging vaginal pathologic conditions, with emphasis on appearance at MRI. Knowledge of vaginal anatomy and embryology is helpful in evaluating congenital anomalies at imaging. Often seen incidentally, vaginal inflammation can cause diagnostic confusion. Because of its central location in the pelvis, the vagina can form fistulas to the urinary bladder, colon, rectum, or anus. Vaginal masses can be neoplastic and nonneoplastic and include a myriad of benign and malignant conditions, some of which have characteristic imaging features. Therapeutic and nontherapeutic vaginal foreign bodies include pessaries, vaginal mesh, and packing that can be seen with or without associated complications. Online supplemental material is available for this article. ^©RSNA, 2021.

The Prevalence of Müllerian Anomalies in Women with a Diagnosed Renal Anomaly

STUDY OBJECTIVE

To characterize the prevalence of Müllerian anomalies (MAs) among patients with renal anomalies (RAs). DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A retrospective chart review of female patients with RAs who presented to an academic pediatric hospital between 2007 and 2019 was performed. Patients were identified using International Classification of Diseases 9th and 10th revision codes. Data collected included the type of RA, presence and type of MA, method of diagnosis, and associated anomalies. RA subtype analysis was performed.

RESULTS

We identified 5590 cases of RA for the years 2007 through 2019. A random, retrospective chart review was performed resulting in a study population of 363 RA patients. The prevalence of any MA in the overall RA population was 104/363 (29%) (95% confidence interval, 24% - 33%). The prevalence of MA for patients with renal agenesis was 59/182 (32%) compared with 45/181 (25%) for patients with renal dysgenesis. The most common MA were failures of Müllerian duct fusion. Only 73/352 (21%) of patients received screening for a MA at the time of RA diagnosis. Of patients without a diagnosed MA 187/259 (72%) were unscreened and either not yet menarchal or had unknown menarchal status.

CONCLUSIONS

Of all RA patients, 29% (n = 104/363) had an underlying MA. No difference was found in the prevalence of MA in patients with renal agenesis vs dysgenesis. Limitations noted are that some patients might be of an age at which assessment of the Müllerian structures is suboptimal or who might not have been screened. These results suggest the need for a prospective study to determine evidence-based guidelines for screening for MA among patients diagnosed with any RA to avoid complications from an unrecognized MA.

Management of Acute Obstructive Uterovaginal Anomalies: ACOG Committee Opinion, Number 779

Obstructive uterovaginal anomalies may present after puberty with amenorrhea, dysmenorrhea, pelvic pain, recurrent vaginal discharge, or infertility. The evaluation of a patient with a suspected obstructive reproductive anomaly should include a detailed medical history, physical examination, and imaging. The genital examination is critical to differentiate a patient with an imperforate hymen from a patient with labial adhesions, urogenital sinus, transverse vaginal septum, or distal vaginal atresia. Pelvic ultrasonography is the initial imaging method recommended for a patient with cyclic pain and amenorrhea or a patient with persistent dysmenorrhea. It is important to note that diagnosis of a uterine or vaginal anomaly by imaging before puberty can be challenging and misleading because of the small size of the prepubertal uterus and the lack of endometrial stimulation and menstrual distention of the vagina. Consultation with a radiologist experienced with imaging of uterovaginal anomalies may be helpful to determine the most accurate diagnosis. In general, obstructive vaginal and uterine anomalies are not surgical emergencies, and the complexities of these conditions are best managed by gynecologic care providers familiar with the surgical management of these conditions. Given the high risk of stenosis and complications associated with transverse vaginal septum, distal vaginal atresia, and cervical atresia, referral to a center with expertise in the management of these anomalies is paramount. The best long-term outcome is achieved with a complete evaluation, clear understanding of the anomaly, mobilization of appropriate surgical resources, sufficient preoperative counseling, and planned surgical intervention.

Pelvic hemorrhagic lesions in women: MRI findings and differential diagnosis

A large spectrum of pathologic pelvic conditions can present with hemorrhage in structures or organs. These may present acutely, subacutely, chronically or as incidental findings. Clinical history and MRI characteristics can often narrow the differential diagnosis and guide management. The purpose of this article is to showcase a wide array of pelvic lesions, in which the presence of blood is a key imaging feature, and their differential diagnosis.

Magnetic resonance imaging of common, uncommon, and rare implantation sites in ectopic pregnancy

OBJECTIVE

To review the MRI appearances of tubal and non-tubal implantation sites in ectopic pregnancy.

CONCLUSION

Transvaginal ultrasound is the primary imaging modality in ectopic pregnancy and MRI is used as a problem-solving tool in selected indications as detailed in the article. MRI features of tubal, interstitial, cervical, cesarean scar, cornual, ovarian, abdominal, and heterotopic pregnancies are provided to familiarize the radiologists with their appearances thereby assisting them in making early and accurate diagnosis.

Magnetic resonance imaging of classified and unclassified Müllerian duct anomalies: Comparison of the American Society for Reproductive Medicine and the European Society of Human Reproduction and Embryology classifications

Magnetic resonance imaging (MRI), due to its optimal delineation of anatomy, has become the mainstay in imaging for diagnosing Müllerian duct anomalies (MDA). Pelvic MRI is requested for various conditions such as primary amenorrhoea, infertility or poor obstetric history with regard to MDA, as identifying the exact aetiology for these conditions is vital. Knowledge regarding the classification of MDA is important, as the treatment varies with respect to the different classes. As all the lesions do not fit within the classification of the American Society for Reproductive Medicine, a new anatomy-based classification was established by the European Society of Human Reproduction and Embryology and the European Society for Gynecological Endoscopy, to fulfil the needs of experts. We aim to discuss various classes of classified and unclassified MDA with regard to both the above-mentioned classifications and illustrate some of them using various cases based on pelvic MRI studies.

Spectrum of MRI Appearance of Mayer-Rokitansky-Kuster-Hauser (MRKH) Syndrome in Primary Amenorrhea Patients

INTRODUCTION

Mayer-Rokitansky-Kuster-Hauser (MRKH) synd-rome is a malformation in female genital tract due to interrupted embryonic development of para-mesonephric ducts leading to uterine and proximal vagina aplasia or hypoplasia.

AIM

To analyse the MRI findings in females suspected of MRKH syndrome in a primary amenorrhea workup.

MATERIALS AND METHODS

A cross-sectional study comprising of 11 patients of MRKH syndrome presented in a tertiary care centre from March 2016 to February 2017 evaluated in 1.5 Tesla MRI scanner.

RESULTS

Normal positioned small vestigial uterus demonstrated in two patients (18.2%) and complete uterine and proximal vaginal agenesis were noted in nine patients (81.8%). The mean volume of rudimentary right uterine bud was 2.26 mL ±3.3 (SD) and left uterine bud was 1.27 mL±1.1 (SD). The mean volume of right ovary was 4.74 mL±2.58 (SD) and left ovary was 4.65 mL±2.2 (SD). The mean developed vaginal length was 26.2 mm±6.34 (SD).

CONCLUSION

The rudimentary uterine buds associated with MRKH syndrome always maintained caudal relationship with ovary. Ovaries or rudimentary uterine buds can be ectopic and should be recognized with MRI before undergoing fertility treatment. Following MRI diagnosis, surgery allows patients to have sexual function with possible attainment of reproduction after assisted reproduction technique or surrogacy.

Diagnostic imaging and cataloguing of female genital malformations

Abstract

To help physicians and radiologists in the diagnosis of female genito-urinary malformations, especially of complex cases, the embryology of the female genital tract, the basis for Müllerian development anomalies, the current classifications for such anomalies and the comparison for inclusion and cataloguing of female genital malformations are briefly reviewed. The use of the embryological system to catalogue female genito-urinary malformations may ultimately be more useful in correlations with clinical presentations and in helping with the appropriate diagnosis and treatment. Diagnostic imaging of the different genito-urinary anomalies are exposed, placing particular emphasis on the anomalies within group II of the embryological and clinical classification (distal mesonephric anomalies), all of them associated with unilateral renal agenesis or dysplasia. Similarly, emphasis is placed on cases of cervico-vaginal agenesis, cavitated noncommunicated uterine horns, and cloacal and urogenital sinus anomalies and malformative combinations, all of them complex malformations. Diagnostic imaging for all these anomalies is essential. The best imaging tools and when to evaluate for other anomalies are also analysed in this review.

Teaching points

• The appropriate cataloguing of female genital malformations is controversial.

• An embryological classification system suggests the best diagnosis and appropriate management.

• The anomalies most frequently diagnosed incorrectly are the distal mesonephric anomalies (DMAs).

• DMAs are associated with unilateral renal agenesis or renal dysplasia with ectopic ureter.

• We analyse other complex malformations. Diagnostic imaging for these anomalies is essential.

Imaging Diagnosis of Herlyn-Werner-Wunderlich Syndrome- An Extremely Rare Urogenital Anomaly

Herlyn-Werner-Wunderlich (HWW) syndrome is a very rare congenital anomaly of the urogenital tract resulting from maldevelopment of both Mullerian and Wolffian ducts. It is characterized by the triad of uterus didelphys, obstructed hemivagina and ipsilateral renal agenesis. It generally presents at puberty shortly following menarche with the symptom of acute pelvic pain. Management of these cases is surgical and consists mainly of vaginoplasty with excision of the vaginal septum in order to release the obstruction and prevent the long term complication of recurrent pyocolpos and infertility. We report here a case of Herlyn-Werner-Wunderlich syndrome in a 13-year-old adolescent girl, emphasizing the role of imaging in the accurate and prompt diagnosis of this rare developmental urogenital anomaly. Only a few hundred such cases have been reported in literature till date.

MRI appearances of benign uterine disease

Benign uterine disease is a common entity affecting women of all ages. Ultrasound has historically been the predominant imaging method used in the evaluation of benign gynaecological disease, magnetic resonance imaging (MRI) being reserved for use in the staging of malignant uterine and cervical disease. MRI is now increasingly used in the diagnosis of benign uterine disease as well as a tool for problem-solving in cases of diagnostic dilemma. It allows detailed assessment of benign conditions, such as endometrial lesions, leiomyomas, and adenomyosis, and can be helpful in the stratification of patients to different treatment modalities, including surgical resection, uterine artery embolization, and medical therapies. In this article, we review the MRI findings in the common benign uterine diseases.

Müllerian duct and related anomalies in children and adolescents

Although many Müllerian duct anomalies do not require treatment, surgical intervention is sometimes necessary to enable sexual activity or to preserve fertility. The identification of these anomalies is important for optimal clinical management or surgical treatment. Magnetic resonance (MR) imaging is a robust method for adequately evaluating and characterizing uterine and vaginal anomalies. The information provided by MR imaging allows for a more complete understanding of the malformation, facilitating management decisions and potentially changing the outcome. In this article, the embryology, classification, and MR imaging findings of Müllerian duct and related anomalies in children and adolescents are reviewed.

Ultrasonography and MRI features of the Mayer-Rokitansky-Küster-Hauser syndrome

Although Mayer-Rokitansky-Küster-Hauser syndrome is a rare condition with a reported incidence of 1/4500 female live births, it represents the second most common cause of primary amenorrhea and has psychologically devastating consequences. The radiologist plays a pivotal role in both making the accurate initial diagnosis of this condition and assessing findings that may contribute to treatment planning. The purpose of this article is to provide an overview of the capabilities of ultrasound and magnetic resonance imaging (MRI) for the diagnosis and management of this syndrome with emphasis on the relevant clinical and surgical findings and to describe potential associated abnormalities and differential diagnosis.

MR imaging findings of ectopic pregnancy: a pictorial review

Because of its lack of ionizing radiation and excellent soft-tissue contrast, magnetic resonance (MR) imaging is being increasingly used in the evaluation of acute abdominal pain in the pregnant patient. Roughly 2% of all pregnancies are ectopic. Although ectopic pregnancy is usually diagnosed on the basis of a combination of clinical, laboratory, and ultrasonographic findings, it occasionally is initially identified at MR imaging. Thus, it is imperative that the radiologist should be familiar with the variable appearance of ectopic pregnancy at MR imaging and should evaluate for ectopic pregnancy at any time when (a) a patient has positive results of a pregnancy test and (b) an intrauterine pregnancy is not definitively seen. Because of potential issues of fetal safety, a conservative approach should be used for MR imaging in pregnancy. An MR imaging protocol for the evaluation of possible appendicitis in pregnant women is detailed. Specific findings that can aid in the diagnosis of ectopic pregnancy are the lack of an intrauterine pregnancy, isolated hemoperitoneum, tubal masses, hematosalpinx, and interstitial masses. In the differential diagnosis of acute abdominal pain in pregnancy, consideration should be given to the more unusual forms of ectopic pregnancy, such as angular pregnancy, cornual pregnancy, and abdominal pregnancy. Potential mimics of ectopic pregnancy include placental abnormalities, ovarian neoplasms, and corpus luteum cysts.

Magnetic resonance imaging diagnosis of Mayer-Rokitansky-Kuster-Hauser syndrome

Magnetic resonance imaging (MRI) is the mainstay in the imaging evaluation of Mullerian agenesis, but is not routinely being utilized, particularly in India. Though sagittal MRI clearly demonstrates the absence or hypoplasia of the uterus and the axial images demonstrate the normal ovaries, it is the ability to identify and objectively evaluate other associated anomalies that makes MRI a unique diagnostic modality. It is also noninvasive and has multiplanar capabilities at the same time having a very high soft tissue resolution. We presume it can be used as a comprehensive imaging package for evaluating these patients at one sitting. We report a case of Mullarian agenesis presenting as primary amenorrhea stressing the role and benefits of MRI.

Successful canalization of a noncommunicating uterine horn by horn-vaginal anastomosis: preliminary findings of a novel approach for an unclassified anomaly

PURPOSE

The aim of this study was to present the preliminary results of a new technique for horn-vaginal anastomosis.

METHODS

Horn-vaginal anastomosis without any dissection at the lower pole of the horn or vaginal apex at the site of anastomosis. This was followed by dilation and silicone stent retention for 4 months.

RESULTS

The patient was a 14-year-old presenting with primary amenorrhea and severe recurrent cyclic lower abdominal pain. The total operative time was 115 minutes. No operative complications were reported. The patient developed stenosis of the tract after 2 successive menstrual periods (MP). The third period was retained. Transvaginal dilatation of the communication tract was successfully accomplished, and a silicon stent was left in place for 5 successive MP. The patient is now menstruating in a regular pattern for 15 successive MP, and an office hysteroscopic examination showed a patent tract with a normal hemicavity leading to a normal tubal ostia.

CONCLUSIONS

Communication between a well-developed noncommunicating uterine horn and vagina was accomplished with successful establishment of the menstrual outflow tract. Regular menstrual pattern was successfully reestablished for 15 consecutive menstrual periods.

Diagnostic accuracy of sonohysterography, hysterosalpingography and diagnostic hysteroscopy in diagnosis of arcuate, septate and bicornuate uterus

AIM

To evaluate the diagnostic accuracy of sonohysterography (SHG), hysterosalpingography (HSG) and diagnostic hysteroscopy (DH) in uterine anomaly detection and to assess the role of these various modalities in the differential diagnosis of arcuate, septate and bicornuate uteri.

METHODS

Eighty-three women, with a history of recurrent spontaneous abortions or infertility and initial diagnosis of uterine anomaly were included in the study. Diagnostic work-up comprised of SHG, HSG and DH. To assess the accuracy of these methods all the patients underwent hysterolaparoscopy to establish the final diagnosis. The correlation between the results of each method was evaluated and diagnostic accuracy of each method was assessed in the whole group of women as well as in subgroups of arcuate, septate and bicornuate uteri using receiver operator curve (ROC) method by estimating the area under the curve (AUC).

RESULTS

In the overall diagnosis of uterine anomalies, SHG with accuracy of 95.2% and correlation index of 0.873 (P < 0.001) proved to be a significantly better tool compared to DH (SHG(AUC) = 0.924 versus DH(AUC) = 0.761 P = 0.008), while no significant differences were observed between SHG versus HSG and DH versus HSG. SHG showed significantly higher accuracy (100.0%) compared to DH (80.7%) and HSG (80.7%) in differentiation of a septate (SHG(AUC) = 1.000 versus DH(AUC) = 0.816 P < 0.001 and SHG(AUC) = 1.000 versus HSG(ACC) = 0.818; P < 0.001) and bicornuate uterus (SGH(AUC) = 1.000 versus DH(ACC) = 0.707; P < 0.001 and SHG(ACC) = 1.000 versus HSG(AUC) = 0.790; P = 0.002).

CONCLUSION

SHG is a noninvasive, cost-effective method available in an outpatient setting that is highly accurate in identifying uterine anomalies, in particular septate and bicornuate uterus.

Magnetic resonance imaging in the preoperative assessment of Mayer-Rokitansky-Kuster-Hauser syndrome

PURPOSE

We evaluated the accuracy of magnetic resonance imaging (MRI) in young women with primary amenorrhoea with suspected Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome (congenital absence of both vagina and uterus and presence of normal ovaries).

MATERIALS AND METHODS

Fifty-eight women (age range 14-30 years, mean 20.9) with primary amenorrhea were studied with MRI performed with a 1.0-T superconducting magnet (Philips NT Intera). All patients were examined in the supine position using a phased-array coil (four channels). Turbo spin-echo T2-weighted images were acquired in the sagittal, axial and coronal planes with the following parameters: TR 4,750-6,686, TE 100-120, FOV 350-375, 4- to 5-mm sections with a 0.4- to 0.5-mm intersection gap and NSA 6. T1-weighted images were acquired in the axial and coronal planes (TR 470, TE 15, FOV 350, 4-mm sections with a 0.6-mm intersection gap, NSA 3). Two experienced radiologists evaluated all the examinations in consensus to assess the presence, position and morphology of vagina, uterus, ovaries and kidneys and any pelvic abnormalities. MRI results were judged on the basis of laparoscopic findings in 41 patients.

RESULTS

MRKH syndrome was confirmed in 56 patients with 100% sensitivity and specificity. MRI identified bilateral Müllerian buds in 34/56 (61%) and unilateral in 10/56 (18%) patients. MRI sensitivity was 81.42%, and there was good agreement with laparoscopy (k=0.55) and full agreement in the identification of cavitation between MRI and intraoperative sonography. Both ovaries were visualised in 54 patients, with regular morphology in 46 (82.1%), polycystic in 10 (17.8%), pelvic in 47 (83.6%) and extrapelvic in eight (14.5%). We found associated abnormalities of the upper urinary tract in six patients (solitary kidney in four and ptosis in two).

CONCLUSIONS

MRI is a useful diagnostic tool in the preoperative evaluation of MRKH syndrome and is less expensive and invasive than laparoscopy. Strong cooperation between radiologists and surgeons is highly recommended.

The role of 3-dimensional ultrasonography and magnetic resonance imaging in the diagnosis of müllerian duct anomalies: a review of the literature

OBJECTIVE

The purpose of this article is to review the published literature and determine the roles that magnetic resonance imaging (MRI) and endovaginal 3-dimensional ultrasonography (3DUS) play in the diagnosis of müllerian duct anomalies (MDAs).

METHODS

A PubMed search was performed to identify all of the articles pertaining to the use of MRI or 3DUS for the evaluation or diagnosis of MDAs. Clinical studies, review articles, case reports, and descriptive studies were reviewed.

RESULTS

Magnetic resonance imaging and 3DUS are highly sensitive and specific in identifying women with MDAs. Magnetic resonance imaging is 100% to 28.6% sensitive and 100% to 66% specific in correctly categorizing MDAs. Three-dimensional ultrasonography is 100% to 98% sensitive and 100% specific in correctly categorizing MDAs.

CONCLUSIONS

In experienced hands, both MRI and 3DUS are adequate modalities for identifying women with MDAs. There is a lack of studies comparing MRI with 3DUS for the diagnosis and categorization of MDAs. However, it seems likely that 3DUS is more sensitive and specific than MRI in categorizing specific types of MDAs. The high sensitivity and specificity of 3DUS make it an ideal tool for identifying women with MDAs that are amenable to hysteroscopic resection. Therefore, we believe that as practitioners become more experienced, 3DUS will emerge as the reference standard for the diagnosis of MDAs.

Indications for body MRI Part II: retroperitoneum, intestines and pelvis

In this article an overview is given of the present knowledge of whole body MRI, MRI of the retroperitoneum, intestines and pelvis. Recommendations are based on current literature and clinical applications in daily routine focusing on efficacy rather than cost considerations. The contribution and complementary role of MRI relative to those of its competing modalities was the most important endpoint assessed. Perfusion and functional information, as well as specific contrast agents in the area of the pelvis are still considered research indications.

MR features of ectopic pregnancy

Ectopic pregnancy (EP), in which a fertilized ovum implants outside the uterine cavity, is the leading cause of pregnancy-related death in the first trimester. EP is usually suspected by a positive pregnancy test and an empty uterus on transvaginal sonography (TVS). Although TVS is the initial modality of choice, it may occasionally fail to demonstrate the implantation site. When TVS findings are indeterminate, magnetic resonance imaging (MRI) may provide better delineation of the focus of EP owing to its excellent tissue contrast. The key MRI features of EP include gestational sac (GS)-like structures that typically appear as a cystic sac-like structure, frequently associated with surrounding acute hematoma of distinct low intensity on T2-weighted images. In tubal pregnancy, an enhanced tubal wall on postcontrast images may be another diagnostic finding. Ruptured EP is inevitably associated with acute hematoma outside these structures. In intrauterine EP, recognition of the relationship between GS-like structure and the myometrium can aid in differentiating from normal pregnancy. Diagnostic pitfalls include heterotopic pregnancy, decidual changes in endometrial cyst and theca lutein cysts mimicking GS-like structures. Knowledge of a spectrum of clinical and MRI features of EP is essential for establishing an accurate diagnosis and determining appropriate management.

[Hematocolpos due to obstructed hemivagina. About three cases]

Abnormalities of the reproductive tract interest a little more than 1% of the women. The symptoms are not specific: abdominal pain seems like appendicitis, invalidating dysmenorrheas in the girl, urinary manifestations. They should be discovered and treated because they could bring about obstetric complications later. We present three observations, illustrated with a recent review of the literature, and describe the diagnostic difficulties and their surgical treatments.

Les urgences abdominales non traumatiques de l’enfant

Do advances in MR imaging and Computed Tomography have encroached upon the private territory of Ultrasound-Doppler imaging on paediatric practice? Do the enthusiasm promoted by the use of CT on non traumatic acute abdomen in adult has contaminated the indomitable village of paediatric radiologist? Undoubtfully, Ultrasound-Doppler stayed the first imaging modality to perform. However, the habits are less crystallised than a few years ago. The goal of this article is to describe the ultrasound findings and the potential indications for MRI or CT in the major non traumatic abdominal paediatric emergencies.