MRI IMAGING APPEARANCE IN MULLERIAN DUCT ANOMALIES.

Background: Müllerian duct anomalies include a complex spectrum of anatomical anomalies that arise from deviations during the normal development of the Müllerian ducts. In paediatrics, such defects cannot present with any clinical symptoms before puberty, yet, they can also have obstructive symptoms or a mass effect due to presence of a non-communicating rudimentary horn or transverse vaginal septum. At the beginning of puberty, girls with these anomalies might have primary amenorrhea, pelvic pain or endometriosis. Müllerian duct anomalies have also associated with a variety of other congenital abnormalities. Aim of the work: To review MRI features of Mullerian Duct Anomalies and classify them according to American Fertility Society and American Society of Reproductive Medicine (AFS/ASRM) and the European Society for Human Reproduction and Embryology (ESHRE) and European Society for Gynecological Endoscopy (ESGE) classifications. Patients and Methods: The study was a case series study that included 37 patients who underwent pelvic MRI at Radiology Department “Ain Shams University hospitals” in Cairo, Egypt. MRI features of Mullerian duct anomalies were reviewed and classified according to the AFS/ASRM and the ESHRE/ESGE classifications. Results: According to AFS/ASRM, uterine anomalies were categorized as none (unclassified) in 2 patients, class 1 (agenesis) in 16 patients, class 2 (unicornuate) in 2 patients, class 3 (didelphys) in 8 patients, class 4 (bicornuate) in 5 patients, class 5 (septate) in 3 patients and class 6 (arcuate) in 1 patient. According to ESHRE/ESGE, the uterus was 0 (normal) in 2 patients, 1 (dysmorphic) in 9 patients, 2 (septate) in 3 patients, 3 (bicorporeal) in 13 patients, 4 (hemi-uterus) in 2 patients and 5 (aplastic) in 8 patients. Similarly, the cervix was 0 (normal) in 17 patients, 2 (double) in 8 patients and 4 (aplasic) in 12 patients and the vagina was 0 (normal) in 16 patients, 1(longitudinal non obstructing vaginal septum) in 1 patient, 2 (longitudinal obstructing vaginal septum) in 5 patients, 3 (transverse vaginal septum) in 3 patients and 4 (aplastic) in 12 patients. Conclusion: MRI is a highly helpful technique for evaluating female genital abnormalities and is able to consistently provide the essential imaging characteristics for the accurate identification of Mullerian malformations. Additionally, incidental pelvic disease and any related renal abnormalities may be thoroughly evaluated by MRI in a single scan, removing the need for additional diagnostic procedures.