Imaging the Female Pelvis: When Should MRI be Considered?

Jennifer Hubert, MD; Diane Bergin, MD

Disclosures

Appl Radiol. 2008;37(1):9-24. 

In This Article

Müllerian Duct Anomalies

The incidence of müllerian duct anomalies is approximately 0.1% to 3%. Although they are often asymptomatic, obstetrical complications occur in up to 25% of these women, including spontaneous abortion, stillbirth, preterm delivery, and adverse obstetrical outcomes. Knowledge of the type and severity of the anomaly can signifcantly impact treatment, as the therapies vary greatly. With an accuracy approaching 100%, MRI has become the gold standard in identifying müllerian duct anomalies.[44,45,46,47] Various studies have shown that it is superior to sonography and hysterosalpingography.[46] In patients with primary amenorrhea, MRI can determine the presence or absence of the vagina, cervix, and uterus.[47] Bicornuate and septate uteri are the 2 most common types of müllerian ductal anomalies. Differentiating between these 2 entities is important because of their complications and different treatments. The evaluation of the external fundal contour is the key to differentiating between bicornuate and septate uteri (Figure 16). This can be best evaluated on a plane that passes through the long axis of the uterus. The outer contour of the septated uterus is convex or flat, with <10-mm concavity. The outer fundal contour of a bicornuate uterus or uterus didelphys should have >10-mm concavity between the right and left uterine horns.

Bicornuate uterus. This axial T2-weighted fast spin-echo image shows a bicornuate uterus with 2 discrete cornua (arrows) and a concave fundal contour (arrowheads).

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