Müllerian duct anomalies – a spectrum of imaging anatomy

Background: Müllerian duct anomalies (MDA) are uncommon but can be a treatable form of infertility. Patients with MDA are known to have higher incidences of infertility, repeated first trimester spontaneous abortions, foetal intra-uterine growth retardation, foetal mal-position, pre-term labour and retained placenta. Aim: The purpose of this study is to identify and categorise Müllerian Duct anomalies using MRI as an imaging modality and to describe the embryological and genetic basis of them. Materials and Methods: A prospective study was designed to include the patients presenting to the infertility clinic at KIMS, Narketpally for primary amenorrhoea, primary infertility and recurrent pregnancy loss during a period of 3 years i.e from 2011 to2014. 200 such patients reported and the cases of Müllerian Duct anomalies were collected and the radiological, embryological and genetic basis was reviewed. Observation: Out of 200 selected cases from the Department of OBG of KIMS, Narketpally, 20 cases were found to have Müllerian Duct anomalies by MRI. Such anomalies were studied, compared with the previous similar studies and classified. Most common among the Müllerian Duct anomalies was Mayer-Rokitansky-Kuster-Hauster (MRKH) syndrome (or) agenesis\ hypoplasia of the uterus where there is primary amenorrhoea. Least common was diethylstilbestrol (DES) uterus. Renal anomalies occur in 29% of the MDA and are more commonly associated with uni-cornuate uterus. They are reported in roughly 40% of the patients with uni-cornuate uterus. Among the renal anomalies renal agenesis is most commonly reported occurring in 67% of the cases. Conclusions: MRI is a gold standard modality of choice used to detect and categorise the cases of MDA.T2WI, fat saturated sagittal sections are best in evaluating the MDA, although coronal and axial sections are also useful. Such study will help in pre conceptional diagnosis and counselling.