The Role of 3-Dimensional Ultrasonography and Magnetic Resonance Imaging in the Diagnosis of Müllerian Duct Anomalies

Abstract

Objective. The purpose of this article is to review the published literature and determine the roles that magnetic resonance imaging (MRI) and endovaginal 3-dimensional ultrasonography (3DUS) play in the diagnosis of müllerian duct anomalies (MDAs). Methods. A PubMed search was performed to identify all of the articles pertaining to the use of MRI or 3DUS for the evaluation or diagnosis of MDAs. Clinical studies, review articles, case reports, and descriptive studies were reviewed. Results. Magnetic resonance imaging and 3DUS are highly sensitive and specific in identifying women with MDAs. Magnetic resonance imaging is 100% to 28.6% sensitive and 100% to 66% specific in correctly categorizing MDAs. Three-dimensional ultrasonography is 100% to 98% sensitive and 100% specific in correctly categorizing MDAs. Conclusions. In experienced hands, both MRI and 3DUS are adequate modalities for identifying women with MDAs. There is a lack of studies comparing MRI with 3DUS for the diagnosis and categorization of MDAs. However, it seems likely that 3DUS is more sensitive and specific than MRI in categorizing specific types of MDAs. The high sensitivity and specificity of 3DUS make it an ideal tool for identifying women with MDAs that are amenable to hysteroscopic resection. Therefore, we believe that as practitioners become more experienced, 3DUS will emerge as the reference standard for the diagnosis of MDAs. Key words: magnetic resonance imaging; müllerian duct anomalies; septate uterus; 3-dimensional ultrasonography; uterine didelphys. üllerian duct anomalies (MDAs) are relatively common disorders, with a prevalence estimated to be around 2% in the general population and 6% to 7% in women with a history of recurrent pregnancy loss. 1Müllerian duct anomalies are associated with recurrent pregnancy loss, intrauterine growth restriction, and preterm labor and birth.2 The prevalence of preterm birth and pregnancy loss varies with the type of MDA (Table 1).3 Furthermore, not all MDAs require surgical correction to improve the pregnancy outcome. In patients with a septate uterus, hysteroscopic metroplasty can substantially improve pregnancy outcomes. In one meta analysis, miscarriage rates dropped from 88% before surgery to 14% after surgery, and the number of term deliveries increased from 3% before surgery to 80% after surgery.

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