Functional (Dynamic Contrast-Enhanced) MRI Assists in the Evaluation of Blood Perfusion in Myometrium and Intrauterine Septi of Women with Symmetric Uterine Anomalies

Abstract

Study Objective Successful reproductive outcomes of patients with uterovaginal anomalies remain in the range of 25-37%, despite applying minimally invasive surgical corrections and assisted reproductive methods. The objective of our study is to introduce functional/dynamic enhanced MRI evaluation of the vascular circulation of the myometrium and intrauterine septum in patients with symmetric uterine anomalies. Design Prospective cohort study. Setting National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia. Patients or Participants 213 patients of patients with symmetric uterine anomalies were evaluated between 2015 and 2017 at our department. Interventions Surgical correction of genital malformations was performed in accordance with clinical manifestations: obstruction of menstrual outflow, abdominal pain, infertility, miscarriage, sexual problems. The new method of functional/dynamic contrast enhanced (DCE) MRI was employed in order to estimate uterine blood perfusion in symmetric uterine malformations. Dynamic monitoring of serial images evaluated the blood supply in the myometrium and septum by digital diagram and color-mapping. Measurements and Main Results The functional MRI was performed in 42 patients requiring surgery, and 30 patients managed without surgical correction. Microcirculation was reduced by over 32 % in most patients with sub-septate uterus, and in 46% of patients with complete uterine septum, increasing the need for hysteroresectoscopic metroplasty in these patients. Histopathologic evaluation of the resected septi identified the presence of significant uterine dysmorphogenesis, vascular malformations, and deep myometrial fibrosis. The asymmetric perfusion of the duplicate uterus was detected in 85% of patients. Successful pregnancy progressed in hemi-uteri with better perfusion results (p Conclusion Functional/dynamic-enhanced MRI identifies the degree of blood perfusion in the myometrium and intrauterine septi of women with symmetric uterine anomalies and may assist in development of surgical and assisted reproductive strategies in the management of these patients.