Congenital Obstructive Müllerian Anomaly: The Pitfalls of a Magnetic Resonance Imaging-Based Diagnosis and the Importance of Intraoperative Biopsy.

Do Young Kim,Gina Nam,Sung Hoon Kim,Byung Moon Kang,Sa Ra Lee,Hee Dong Chae

doi:10.3390/jcm10112414

Abstract

A retrospective cohort study of the concordance between the magnetic resonance imaging (MRI) diagnosis and final diagnosis in patients with Müllerian duct anomalies (MDAs) was conducted, and diagnostic clues were suggested. A total of 463 cases of young women who underwent pelvic MRIs from January 1995 to February 2019 at Seoul Asan Medical Center were reviewed. Interventions consisted of clinical examinations, abdominal or transvaginal/rectal ultrasound, MRI, and operative procedures, including hysteroscopy and laparoscopy. The concordance of the diagnosis between the results obtained with MRI and those obtained with surgeries was evaluated. It was found that a total of 225 cases (48.6%) showed genital tract anomalies on MRI. Among them, 105 cases (46.7%) underwent reconstructive surgery. Nineteen cases (8.4%) revealed discrepancies between the final diagnosis after surgery and the initial MRI findings and eleven cases (57.9%) had cervical anomalies. Incorrect findings associated with the MRIs were particularly evident in biopsied cases of cervical dysgenesis. A combination of physical examination, ultrasound, and MRI is suitable for preoperative work-up in the diagnoses of congenital obstructive anomalies. However, it is recommended that a pathologic confirmation of tissue at the caudal leading edge be made in obstructive genital anomalies, in cases of presumptive vaginal or cervical dysgenesis.

Highlights

Congenital Müllerian duct anomalies (MDAs) are relatively common, and diverse types of this condition have been reported [1]
Obstructive reproductive tract anomalies include an imperforate hymen, distal vaginal atresia or agenesis, transverse vaginal septum, cervical dysgenesis or agenesis, and an obstructive hemivagina with an ipsilateral renal anomaly (OHVIRA) [5], an imperforate hymen is derived from the urogenital sinus and does not have a Müllerian duct origin
We focused on the preoperative description of MR images that showed vaginal or cervical dysgenesis or agenesis

Summary

Introduction

Congenital Müllerian duct anomalies (MDAs) are relatively common, and diverse types of this condition have been reported [1]. MDAs can be categorized as obstructive and nonobstructive anomalies. Obstructive reproductive tract anomalies include an imperforate hymen, distal vaginal atresia or agenesis, transverse vaginal septum, cervical dysgenesis or agenesis, and an obstructive hemivagina with an ipsilateral renal anomaly (OHVIRA) [5], an imperforate hymen is derived from the urogenital sinus and does not have a Müllerian duct origin. Among various obstructive reproductive tract anomalies, differential diagnoses between cervical dysgenesis or agenesis and vaginal agenesis are especially important because the impact of these conditions on women’s sexual and reproductive potential can be significantly different. Differentiation between the two is often difficult, even for experienced gynecologists and radiologists. The incidence of vaginal agenesis ranges from

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