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Imaging of Congenital Uterine Anomalies: Review and Self-Assessment Module

Thomas M. Dykes1, Cary Siegel2 and William Dodson1

1 Department of Radiology, Pennsylvania State University, Milton S. Hershey Medical Center, 500 University Drive, P.O. Box 850, Hershey, PA 17033.
2 Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO.


Figure 1
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  		Fig. 1 —Classification system of müllerian duct anomalies used by the American Society for Reproductive Medicine [3] (Reprinted with permission). DES=diethylstilbestrol.

 

Figure 2
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  		Fig. 2A —Sagittal localizer sequence in healthy patient shows imaging planes required for T2 imaging sequences. T2-weighted sagittal MR localizer sequence.

 

Figure 3
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  		Fig. 2B —Sagittal localizer sequence in healthy patient shows imaging planes required for T2 imaging sequences. Imaging plane prescription (white lines) for T2-weighted MR sequence parallel to the uterine long-axis.

 

Figure 4
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  		Fig. 2C —Sagittal localizer sequence in healthy patient shows imaging planes required for T2 imaging sequences. Imaging plane prescription (white lines) for T2-weighted MR sequence orthogonal to the uterine long-axis.

 

Figure 5
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  		Fig. 3A —Hysterosalpingogram for recurrent pregnancy loss. MRI obtained subsequent to hysterosalpingography. Hysterosalpingogram shows one uterine horn filled during injection (arrow).

 

Figure 6
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  		Fig. 3B —Hysterosalpingogram for recurrent pregnancy loss. MRI obtained subsequent to hysterosalpingography. Axial T2 MRI shows fusiform uterine cavity with typical trilaminar appearance of high-signal endometrium (star), low-signal junctional zone (long arrow), and intermediate-signal myometrium (short arrow) of uterus seen in right side of pelvis. This corresponds to cavity opacified on hysterosalpingogram.

 

Figure 7
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  		Fig. 3C —Hysterosalpingogram for recurrent pregnancy loss. MRI obtained subsequent to hysterosalpingography. Axial T2 MRI slightly lower in pelvis shows second endometrial cavity in left side of pelvis with high-signal endometrium (arrow). There is clear separation of this second cavity from more superior cavity by intermediate-signal myometrium.

 

Figure 8
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  		Fig. 4A —Hysterosalpingogram and subsequent MRI. Hysterosalpingogram demonstrating filling of a left-sided unicornuate uterus (arrow).

 

Figure 9
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  		Fig. 4B —Hysterosalpingogram and subsequent MRI. Axial T2 MRI shows the unicornuate horn corresponding to that seen on the hysterosalpingogram (arrow). A low-signal-intensity fibrous rudimentary horn is seen in the right pelvis (arrowhead).

 

Figure 10
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  		Fig. 4C —Hysterosalpingogram and subsequent MRI. Coronal T2 MRI better demonstrates the noncavitary (no high-signal endometrium) right-sided rudimentary horn attached to the left-sided unicornuate horn (arrow).

 

Figure 11
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  		Fig. 5A —Two separate cervices visualized. Two separate injections on hysterosalpingography. Two cervices were visualized and cannulated separately. Opacified uterine horns do not communicate and are widely divergent (arrows).

 

Figure 12
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  		Fig. 5B —Two separate cervices visualized. Two separate injections on hysterosalpingography. Two cervices were visualized and cannulated separately. Opacified uterine horns do not communicate and are widely divergent (arrows).

 

Figure 13
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  		Fig. 6A —Two separate cervices visualized. T2 axial MRI show two, widely separate uterine horns in a patient with uterus didelphus (arrows).

 

Figure 14
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  		Fig. 6B —Two separate cervices visualized. T2 coronal MRI demonstrates separate, noncommunicating uterine horns (black arrows) and cervices (arrowheads) and duplicated vagina (white arrows).

 

Figure 15
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  		Fig. 7A —Woman with vaginal bleeding and abdominal pain. Uterus didelphus. Coronal T2 image demonstrates a dilated right-sided uterine horn (arrow) and a nondilated left-sided uterine horn (arrowhead).

 

Figure 16
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  		Fig. 7B —Woman with vaginal bleeding and abdominal pain. Uterus didelphus. Axial T2 image demonstrates the dilated right-sided uterine horn (arrow), nondilated left-sided uterine horn (arrowhead), and a massively dilated, obstructed right hemivagina (star).

 

Figure 17
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  		Fig. 8A —Two uterine cavities seen on previous hysterosalpingogram after cannulating single cervix. T2 axial MRI shows two separate uterine cavities (white arrows) separated by deep fundal cleft (black arrow) at uterine fundus. Single cervix is present.

 

Figure 18
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  		Fig. 8B —Two uterine cavities seen on previous hysterosalpingogram after cannulating single cervix. T2 coronal MRI shows communication of two uterine cavities in lower uterine segment (arrow).

 

Figure 19
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  		Fig. 9 —Double uterine horn is present on hysterosalpingogram. Free spill of contrast into peritoneal cavity allows direct visualization of convex fundal contour (arrowheads) confirming that this is septate uterus, not bicornuate.

 

Figure 20
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  		Fig. 10A —Woman with recurrent pregnancy loss. Hysterosalpingogram with injection of one cervix demonstrates two separate uterine cavities with communication in lower uterine segment.

 

Figure 21
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  		Fig. 10B —Woman with recurrent pregnancy loss. Axial T2 MRI shows flat external uterine fundal contour (arrowheads).

 

Figure 22
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  		Fig. 10C —Woman with recurrent pregnancy loss. Axial T2 MRI lower in pelvis demonstrates single cervix with no septation (arrowhead).

 

Figure 23
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  		Fig. 11A —No clinical history available. T2 axial MRI: Septate uterus, complete. Arrowhead demonstrates shallow (< 1 cm depth) fundal concavity, still consistent with septate morphology.

 

Figure 24
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  		Fig. 11B —No clinical history available. T2 axial MRI slightly lower in pelvis. White arrow shows long fibrous (low signal) septum extending to external cervical os consistent with complete septate uterus. Arrowhead shows shallow cleft in fundus, still consistent with septate uterus.

 

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