P-465: Magnetic Resonance Imaging versus three dimensional transvaginal ultrasound for the diagnosis of Mullerian anomalies

Abstract

The purpose of this study is to compare the diagnostic accuracy of Magnetic Resonance Imaging (MRI) with 3 dimensional transvaginal ultrasound (3DUS) for the diagnosis of Mullerian anomalies. Prospective analysis of all patients evaluated at a tertiary fertility center between 2004 and 2005 for Mullerian anomalies. The study included all patients evaluated at a tertiary fertility center between 2004 and 2005 with surgically confirmed Mullerian anomaly. Thirteen patients were included in the study. Seven of the patients had undergone both a 3DUS and a MRI (Group A) and 6 of the patients had undergone only a 3DUS (Group B). All 3DUS were performed at our center by a qualified ultrasonographer and read by an attending trained in gynecologic ultrasound. The MRIs were performed at various institutions in the area and read by a radiologist. Each patient was placed into one of three categories based on their operative report: uterine septum, bicornuate uterus or no anomaly. The surgical diagnosis was used as the gold standard for diagnosis. Each patient’s MRI and/or 3DUS diagnosis was evaluated to determine if it was in agreement with the surgical diagnosis. The proportion of correct MRIs in Group A was compared to the proportion of correct 3DUSs in the group B using the Fisher exact test. Every patient identified as having a mullerian anomaly by either MRI or 3DUS was surgically proven to have an anomaly. However, the uterus was correctly characterized as septate or bicornuate 100% of the time with 3DUS but only 28.6% of the time with MRI. In the analysis of group A vs. Group B, 3DUS was found to be more accurate at diagnosing types of mullerian anomalies than MRI with a P value of 0.016. MRI and 3DUS are both capable of diagnosing Mullerian anomalies. However, 3DUS appears to be superior to MRI in differentiating between patients who have a bicornuate or septate uterus. The ability of 3DUS to accurately characterize Mullerian anomalies essentially eliminates the need for a diagnostic laparoscopy. In addition, 3DUS can be used to identify patients who were incorrectly diagnosed by MRI as having a bicornuate uterus and might benefit from hysteroscopic septal resection. Therefore, because of its relative low cost and superior diagnostic capability, 3DUS should be the modality of choice when evaluating a patient for a Mullerian anomaly.Tabled 1