HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) CME Credit Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mueller, G. C. Articles by DeLancey, J. O. Search for Related Content PubMed PubMed Citation Articles by Mueller, G. C. Articles by DeLancey, J. O. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?

Müllerian Duct Anomalies: Comparison of MRI Diagnosis and Clinical Diagnosis

¹ Department of Radiology/MRI (UH-B2A209K), University of Michigan Health System, 1500 E Medical Center Dr., Ann Arbor, MI 48109-0030.
² Department of Obstetrics and Gynecology, University of Michigan Health System, Ann Arbor, MI.
³ Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI.

View larger version (188K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Premature infant with XY genotype–female phenotype and multiple congenital anomalies (patient 4 in Table 4). Sagittal (A) and axial (B) T2-weighted fast spin-echo (SE) images (TR/TE, 4,200/96) and axial T1-weighted SE image (C) (520/8) of pelvis show teardrop-shaped fluid-filled structure (black arrow) posterior to urinary bladder (white arrow). This finding was believed to represent hydrometrocolpos. No müllerian structures were found at surgery performed 18 months later.

View larger version (156K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Premature infant with XY genotype–female phenotype and multiple congenital anomalies (patient 4 in Table 4). Sagittal (A) and axial (B) T2-weighted fast spin-echo (SE) images (TR/TE, 4,200/96) and axial T1-weighted SE image (C) (520/8) of pelvis show teardrop-shaped fluid-filled structure (black arrow) posterior to urinary bladder (white arrow). This finding was believed to represent hydrometrocolpos. No müllerian structures were found at surgery performed 18 months later.

View larger version (167K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —Premature infant with XY genotype–female phenotype and multiple congenital anomalies (patient 4 in Table 4). Sagittal (A) and axial (B) T2-weighted fast spin-echo (SE) images (TR/TE, 4,200/96) and axial T1-weighted SE image (C) (520/8) of pelvis show teardrop-shaped fluid-filled structure (black arrow) posterior to urinary bladder (white arrow). This finding was believed to represent hydrometrocolpos. No müllerian structures were found at surgery performed 18 months later.

View larger version (207K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —34-year-old woman with history of infertility and bicornuate versus septate uterus on hysterosalpingography (patient 8 in Table 4). Long-axis (A) and short-axis (B) T2-weighted fast spin-echo images (TR/TE, 5,000/96) of lower uterine segment. In addition to very short septum at fundus, there is low-signal longitudinal structure within uterine cervix (arrow, A) consistent with prominent cervical mucosal fold. This finding was misinterpreted as complete septum in prospective reading. Short-axis image (B) shows that this structure corresponds to mucosa fold (arrows, B) and not to septum. Hysteroscopy (not shown) revealed very short (12-mm) fundal septum only.

View larger version (193K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —34-year-old woman with history of infertility and bicornuate versus septate uterus on hysterosalpingography (patient 8 in Table 4). Long-axis (A) and short-axis (B) T2-weighted fast spin-echo images (TR/TE, 5,000/96) of lower uterine segment. In addition to very short septum at fundus, there is low-signal longitudinal structure within uterine cervix (arrow, A) consistent with prominent cervical mucosal fold. This finding was misinterpreted as complete septum in prospective reading. Short-axis image (B) shows that this structure corresponds to mucosa fold (arrows, B) and not to septum. Hysteroscopy (not shown) revealed very short (12-mm) fundal septum only.

View larger version (193K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —15-year-old girl with primary amenorrhea, pelvic pain, and vaginal agenesis on clinical examination (patient 7 in Table 4). Uterus was visualized at laparotomy performed at another institution. MRI was requested to evaluate cervix. Sagittal (A) and long-axis (B) T2-weighted fast spin-echo (SE) images (TR/TE, 5,200/96) show lack of normal endometrial stripe. Instead, uterus is filled with blood seen as high signal intensity (white arrow, C) on axial T1-weighted SE image (C) (600/12) and as dark signal intensity (white arrows, A and B) on T2-weighted images (A and B). Cervix is identified, but normal cervical canal is not seen. High-signal-intensity structures (black arrows) are blood-filled cysts. Total abdominal hysterectomy showed cervical dysgenesis and absence of endocervical canal.

View larger version (189K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —15-year-old girl with primary amenorrhea, pelvic pain, and vaginal agenesis on clinical examination (patient 7 in Table 4). Uterus was visualized at laparotomy performed at another institution. MRI was requested to evaluate cervix. Sagittal (A) and long-axis (B) T2-weighted fast spin-echo (SE) images (TR/TE, 5,200/96) show lack of normal endometrial stripe. Instead, uterus is filled with blood seen as high signal intensity (white arrow, C) on axial T1-weighted SE image (C) (600/12) and as dark signal intensity (white arrows, A and B) on T2-weighted images (A and B). Cervix is identified, but normal cervical canal is not seen. High-signal-intensity structures (black arrows) are blood-filled cysts. Total abdominal hysterectomy showed cervical dysgenesis and absence of endocervical canal.

View larger version (161K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —15-year-old girl with primary amenorrhea, pelvic pain, and vaginal agenesis on clinical examination (patient 7 in Table 4). Uterus was visualized at laparotomy performed at another institution. MRI was requested to evaluate cervix. Sagittal (A) and long-axis (B) T2-weighted fast spin-echo (SE) images (TR/TE, 5,200/96) show lack of normal endometrial stripe. Instead, uterus is filled with blood seen as high signal intensity (white arrow, C) on axial T1-weighted SE image (C) (600/12) and as dark signal intensity (white arrows, A and B) on T2-weighted images (A and B). Cervix is identified, but normal cervical canal is not seen. High-signal-intensity structures (black arrows) are blood-filled cysts. Total abdominal hysterectomy showed cervical dysgenesis and absence of endocervical canal.

View larger version (192K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —32-year-old woman with history of miscarriage (patient 12 in Table 4). Long-uterine-axis T2-weighted fast spin-echo image (TR/TE, 4,800/86) image shows flat outer fundal contour and saddlelike indentation of endometrial cavity consistent with arcuate uterus. However, there is wide intercornual distance of more than 4 cm. Prospective MRI interpretation and clinical impression were problematic, likely due to unusually wide intercornual distance. There is no consensus on defining depth of indentation to differentiate arcuate configuration from broad muscular septum. Characterizing this uterus as septate with incomplete septum may lead to unnecessary surgery.

View larger version (170K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —30-year-old woman old with primary infertility, longitudinal vaginal septum, and two cervices on clinical examination (patient 19 in Table 5). Long-axis (A) and short-axis (B) T2-weighted fast spin-echo images (TR/TE, 4,800/86) of uterus and short-axis plane image of cervix (C) show flat outer fundal contour (black arrow, A and B) and complete septum extending to external cervical os (white arrow, B and C), consistent with septate uterus with complete septum.

View larger version (198K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —30-year-old woman old with primary infertility, longitudinal vaginal septum, and two cervices on clinical examination (patient 19 in Table 5). Long-axis (A) and short-axis (B) T2-weighted fast spin-echo images (TR/TE, 4,800/86) of uterus and short-axis plane image of cervix (C) show flat outer fundal contour (black arrow, A and B) and complete septum extending to external cervical os (white arrow, B and C), consistent with septate uterus with complete septum.

View larger version (195K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —30-year-old woman old with primary infertility, longitudinal vaginal septum, and two cervices on clinical examination (patient 19 in Table 5). Long-axis (A) and short-axis (B) T2-weighted fast spin-echo images (TR/TE, 4,800/86) of uterus and short-axis plane image of cervix (C) show flat outer fundal contour (black arrow, A and B) and complete septum extending to external cervical os (white arrow, B and C), consistent with septate uterus with complete septum.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6 —27-year-old woman, gravida 1, para 1, with secondary infertility (patient 20 in Table 5) and suggestion of unicornuate uterus on hysterosalpingography (not shown). Short-uterine-axis T2-weighted fast spin-echo image (TR/TE, 5,800/92) shows typical appearance of unicornuate uterus (arrow) with rudimentary horn. There appears to be endometrium within rudimentary horn (arrowhead). On laparoscopy and hysteroscopy (not shown), rudimentary horn was shown to be communicating with main cavity, resulting in clinical impression of bicornuate uterus with asymmetric size of horns.

CiteULike

Complore

Connotea

Del.icio.us

Digg

Reddit

Technorati