Published online before print August 18, 2004, 10.1148/radiol.2331020777
(Radiology 2004;233:19.)
A more recent version of this article appeared on October 1, 2004
Müllerian Duct Anomalies: Imaging and Clinical Issues1
Robert N. Troiano, MD and
Shirley M. McCarthy, MD, PhD
1 From the Departments of Radiology and Obstetrics and Gynecology, Weill Medical College of Cornell University, 1300 York Ave, New York, NY 10021 (R.M.T.), and Department of Radiology, Yale University School of Medicine, New Haven, Conn (S.M.M.). Received June 25, 2002; revision requested August 22; final revision received August 25, 2003; accepted September 29. Address correspondence to R.N.T. (e-mail: rnt2001@med.cornell.edu).
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Figure 1a. (a) Sagittal inversion-recovery MR image (4500/130/150 [repetition time msec/echo time msec/inversion time msec]) is used to determine plane for obtaining images parallel to the long axis of the uterus. (b) Coronal single-shot fast spin-echo T2-weighted MR image (minimum repetition time, 180-msec echo time) of the retroperitoneum obtained to assess the kidneys shows congenitally absent left kidney.
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Figure 1b. (a) Sagittal inversion-recovery MR image (4500/130/150 [repetition time msec/echo time msec/inversion time msec]) is used to determine plane for obtaining images parallel to the long axis of the uterus. (b) Coronal single-shot fast spin-echo T2-weighted MR image (minimum repetition time, 180-msec echo time) of the retroperitoneum obtained to assess the kidneys shows congenitally absent left kidney.
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Figure 2. Classification system of müllerian duct anomalies developed by the American Fertility Society (43).
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Figure 3a. Uterine septum. (a) Laparoscopic image shows flat external uterine fundal contour. (b) Hysteroscopic image shows intervening septum (arrow). (Reprinted, with permission, from reference 43.)
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Figure 3b. Uterine septum. (a) Laparoscopic image shows flat external uterine fundal contour. (b) Hysteroscopic image shows intervening septum (arrow). (Reprinted, with permission, from reference 43.)
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Figure 4a. HSG demonstration of septate versus bicornuate uteri. (a) Acute angle of divergence between uterine horns is most suggestive of a septate uterus (arrow). (b, c) Indeterminate angles of divergence may suggest either (b) septate uterus (arrow) or (c) bicornuate uterus (arrow). Final diagnoses were based on subsequent MR imaging results (not shown).
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Figure 4b. HSG demonstration of septate versus bicornuate uteri. (a) Acute angle of divergence between uterine horns is most suggestive of a septate uterus (arrow). (b, c) Indeterminate angles of divergence may suggest either (b) septate uterus (arrow) or (c) bicornuate uterus (arrow). Final diagnoses were based on subsequent MR imaging results (not shown).
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Figure 4c. HSG demonstration of septate versus bicornuate uteri. (a) Acute angle of divergence between uterine horns is most suggestive of a septate uterus (arrow). (b, c) Indeterminate angles of divergence may suggest either (b) septate uterus (arrow) or (c) bicornuate uterus (arrow). Final diagnoses were based on subsequent MR imaging results (not shown).
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Figure 5a. Septate uterus. (a) HSG image shows wide divergence of opacified endometrial cavities simulating a bicornuate configuration. (b) Corresponding coronal oblique fast spin-echo T2-weighted MR image (6000/120 [effective]) demonstrates insinuated leiomyoma (long arrow) within the septum, causing exaggerated separation of cavities. Note lateral wall myoma with cystic degeneration (short arrow) also causing distortion of left endometrial cavity.
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Figure 5b. Septate uterus. (a) HSG image shows wide divergence of opacified endometrial cavities simulating a bicornuate configuration. (b) Corresponding coronal oblique fast spin-echo T2-weighted MR image (6000/120 [effective]) demonstrates insinuated leiomyoma (long arrow) within the septum, causing exaggerated separation of cavities. Note lateral wall myoma with cystic degeneration (short arrow) also causing distortion of left endometrial cavity.
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Figure 6. Coronal oblique reconstructed three- dimensional endovaginal US image of a partial uterine septum demonstrates mild indentation of the uterine fundus with no intervening cleft (short arrow) and septum separating endometrial cavities (long arrow). (Image courtesy of Anna Lev-Toaff, MD, Thomas Jefferson University, Philadelphia, Pa.)
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Figure 7. Classification criteria for US differentiation of septate from bicornuate uteri. A, When apex (3) of the fundal external contour occurs below a straight line between the tubal ostia (1, 2) or, B, 5 mm (arrow) above it, the uterus is bicornuate. C, When apex is more than 5 mm (arrow) above the line, uterus is septate.
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Figure 8a. MR images of complete uterine septum. (a) Transverse oblique fast spin-echo T2-weighted image (7150/120) shows convex external uterine contour with upper myometrial segment (short arrow) and lower fibrous segment (long arrow) extending to external uterine os. (b) Transverse fast spin-echo T2-weighted image (6000/115) shows vertical septum extending to upper third of vagina (arrow). (Reprinted, with permission, from reference 43.)
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Figure 8b. MR images of complete uterine septum. (a) Transverse oblique fast spin-echo T2-weighted image (7150/120) shows convex external uterine contour with upper myometrial segment (short arrow) and lower fibrous segment (long arrow) extending to external uterine os. (b) Transverse fast spin-echo T2-weighted image (6000/115) shows vertical septum extending to upper third of vagina (arrow). (Reprinted, with permission, from reference 43.)
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Figure 9a. MR images of partial uterine septum. (a) Coronal oblique fast spin-echo T2-weighted image (6000/120) shows flat external uterine contour with prominent upper myometrial component (short arrow) and small lower fibrous component (long arrow). (b) Coronal oblique fast spin-echo T2-weighted image (6100/110) shows partial septum with insinuated leiomyomas (arrow). (c, d) Coronal oblique fast spin-echo T2-weighted images (6000/105) show partial septum with extensive adenomyosis (curved arrows). Note concave external uterine contour (straight arrow).
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Figure 9b. MR images of partial uterine septum. (a) Coronal oblique fast spin-echo T2-weighted image (6000/120) shows flat external uterine contour with prominent upper myometrial component (short arrow) and small lower fibrous component (long arrow). (b) Coronal oblique fast spin-echo T2-weighted image (6100/110) shows partial septum with insinuated leiomyomas (arrow). (c, d) Coronal oblique fast spin-echo T2-weighted images (6000/105) show partial septum with extensive adenomyosis (curved arrows). Note concave external uterine contour (straight arrow).
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Figure 9c. MR images of partial uterine septum. (a) Coronal oblique fast spin-echo T2-weighted image (6000/120) shows flat external uterine contour with prominent upper myometrial component (short arrow) and small lower fibrous component (long arrow). (b) Coronal oblique fast spin-echo T2-weighted image (6100/110) shows partial septum with insinuated leiomyomas (arrow). (c, d) Coronal oblique fast spin-echo T2-weighted images (6000/105) show partial septum with extensive adenomyosis (curved arrows). Note concave external uterine contour (straight arrow).
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Figure 9d. MR images of partial uterine septum. (a) Coronal oblique fast spin-echo T2-weighted image (6000/120) shows flat external uterine contour with prominent upper myometrial component (short arrow) and small lower fibrous component (long arrow). (b) Coronal oblique fast spin-echo T2-weighted image (6100/110) shows partial septum with insinuated leiomyomas (arrow). (c, d) Coronal oblique fast spin-echo T2-weighted images (6000/105) show partial septum with extensive adenomyosis (curved arrows). Note concave external uterine contour (straight arrow).
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Figure 10a. MR images of complete uterine septum with cervical duplication. Fast spin-echo T2-weighted images obtained in (a) transverse oblique (7300/120) and (b) coronal oblique (7216/105) planes show enlarged cervical segment with two distinct cervices, each with preserved zonal anatomy (arrows).
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Figure 10b. MR images of complete uterine septum with cervical duplication. Fast spin-echo T2-weighted images obtained in (a) transverse oblique (7300/120) and (b) coronal oblique (7216/105) planes show enlarged cervical segment with two distinct cervices, each with preserved zonal anatomy (arrows).
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Figure 11. Diagram of arcuate uterus ratio. When ratio of height (H) to length (L) is less than 10%, an adverse reproductive outcome is not expected. (Reprinted, with permission, from reference 63.)
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Figure 12. Arcuate uterus. HSG image demonstrates broad fundal indentation (arrow).
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Figure 13. Arcuate uterus. Transverse fast spin-echo T2-weighted MR image (6166/130) demonstrates nonspecific low signal intensity of fundal myometrium (arrow).
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Figure 14a. Bicornuate uterus. (a) Transverse US image and (b) corresponding transverse oblique fast spin-echo T2-weighted MR image (7250/105) demonstrate external fundal cleft (straight arrow) with wide divergence of endometrial cavities. Note leiomyoma (curved arrow) in right lateral wall.
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Figure 14b. Bicornuate uterus. (a) Transverse US image and (b) corresponding transverse oblique fast spin-echo T2-weighted MR image (7250/105) demonstrate external fundal cleft (straight arrow) with wide divergence of endometrial cavities. Note leiomyoma (curved arrow) in right lateral wall.
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Figure 15a. MR images of bicornuate uterus. Fast spin-echo T2-weighted images in (a) coronal oblique (5650/105) and (b) transverse (6000/130) planes provide two examples of bicornuate uteri and demonstrate wide divergence of uterine horns, with communication of endometrial cavities in the lower uterine body (arrow).
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Figure 15b. MR images of bicornuate uterus. Fast spin-echo T2-weighted images in (a) coronal oblique (5650/105) and (b) transverse (6000/130) planes provide two examples of bicornuate uteri and demonstrate wide divergence of uterine horns, with communication of endometrial cavities in the lower uterine body (arrow).
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Figure 16a. Uterus didelphys. (a, b) HSG images show catheterization of two separate cervices with opacification of two widely divergent noncommunicating endometrial cavities (arrow).
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Figure 16b. Uterus didelphys. (a, b) HSG images show catheterization of two separate cervices with opacification of two widely divergent noncommunicating endometrial cavities (arrow).
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Figure 17a. Uterus didelphys. (a, b) Transverse fast spin-echo T2-weighted MR images (7216/130) show complete duplication of uterine horns (short arrows), with partial degree of fusion of adjacent cervices (long arrows).
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Figure 17b. Uterus didelphys. (a, b) Transverse fast spin-echo T2-weighted MR images (7216/130) show complete duplication of uterine horns (short arrows), with partial degree of fusion of adjacent cervices (long arrows).
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Figure 18. Unicornuate uterus. HSG image shows fusiform configuration of opacified endometrial cavity (arrow), with opacification of one fallopian tube.
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Figure 19a. Unicornuate uterus. (a) Transverse and (b) sagittal two-dimensional endovaginal US images demonstrate uterus without gross morphologic anomaly. (c) Three-dimensional reconstructed transverse oblique US image shows an abnormal lenticular shape of endometrial cavity (long arrow) with asymmetric tapering at the cornua (short arrow). (Image courtesy of Anna Lev-Toaff, Thomas Jefferson University, Philadelphia, Pa.)
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Figure 19b. Unicornuate uterus. (a) Transverse and (b) sagittal two-dimensional endovaginal US images demonstrate uterus without gross morphologic anomaly. (c) Three-dimensional reconstructed transverse oblique US image shows an abnormal lenticular shape of endometrial cavity (long arrow) with asymmetric tapering at the cornua (short arrow). (Image courtesy of Anna Lev-Toaff, Thomas Jefferson University, Philadelphia, Pa.)
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Figure 19c. Unicornuate uterus. (a) Transverse and (b) sagittal two-dimensional endovaginal US images demonstrate uterus without gross morphologic anomaly. (c) Three-dimensional reconstructed transverse oblique US image shows an abnormal lenticular shape of endometrial cavity (long arrow) with asymmetric tapering at the cornua (short arrow). (Image courtesy of Anna Lev-Toaff, Thomas Jefferson University, Philadelphia, Pa.)
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Figure 20a. Unicornuate uterus. Transverse oblique T2-weighted MR images (6000/105) show (a) unicornuate uterus (short arrow) with no associated rudimentary horn and (b) unicornuate uterus with rudimentary horn (long arrow) and no associated endometrium.
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Figure 20b. Unicornuate uterus. Transverse oblique T2-weighted MR images (6000/105) show (a) unicornuate uterus (short arrow) with no associated rudimentary horn and (b) unicornuate uterus with rudimentary horn (long arrow) and no associated endometrium.
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Figure 21a. MR images of complex anomaly. (a) Transverse oblique T2-weighted image (6000/120) shows bicornuate configuration of uterine horns (short arrows) with lower uterine body septum extending through the cervix (long arrow). (b) Transverse fast spin-echo T2-weighted image (6000/105) shows focal duplication of the vagina (arrow).
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Figure 21b. MR images of complex anomaly. (a) Transverse oblique T2-weighted image (6000/120) shows bicornuate configuration of uterine horns (short arrows) with lower uterine body septum extending through the cervix (long arrow). (b) Transverse fast spin-echo T2-weighted image (6000/105) shows focal duplication of the vagina (arrow).
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Figure 22. Unicornuate uterus. Transverse oblique T2-weighted MR image (7400/105) shows large rudimentary horn demonstrating a noncommunicating endometrial segment (arrow).
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Figure 23. DES exposure. HSG image shows T configuration of endometrial cavity (arrow).
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Figure 24a. DES exposure. (a, b) Coronal oblique fast spin-echo T2-weighted MR images (6750/105) show T configuration, constriction bands (long arrows), and cavitary narrowing (short arrows).
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Figure 24b. DES exposure. (a, b) Coronal oblique fast spin-echo T2-weighted MR images (6750/105) show T configuration, constriction bands (long arrows), and cavitary narrowing (short arrows).
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Figure 25a. MR images of vaginal agenesis and uterine hypoplasia and agenesis. (a) Transverse fast spin-echo T2-weighted image (6000/130) shows vaginal agenesis demonstrating complete absence of normal vaginal tissue (arrow). (b) Sagittal fast spin-echo T2-weighted image (6616/104) shows uterine hypoplasia with a small uterine remnant (arrow) and no normal zonal anatomy. (c) Sagittal fast spin-echo T2-weighted image (6500/110) shows uterine agenesis with no evidence of uterine tissue (arrow).
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Figure 25b. MR images of vaginal agenesis and uterine hypoplasia and agenesis. (a) Transverse fast spin-echo T2-weighted image (6000/130) shows vaginal agenesis demonstrating complete absence of normal vaginal tissue (arrow). (b) Sagittal fast spin-echo T2-weighted image (6616/104) shows uterine hypoplasia with a small uterine remnant (arrow) and no normal zonal anatomy. (c) Sagittal fast spin-echo T2-weighted image (6500/110) shows uterine agenesis with no evidence of uterine tissue (arrow).
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Figure 25c. MR images of vaginal agenesis and uterine hypoplasia and agenesis. (a) Transverse fast spin-echo T2-weighted image (6000/130) shows vaginal agenesis demonstrating complete absence of normal vaginal tissue (arrow). (b) Sagittal fast spin-echo T2-weighted image (6616/104) shows uterine hypoplasia with a small uterine remnant (arrow) and no normal zonal anatomy. (c) Sagittal fast spin-echo T2-weighted image (6500/110) shows uterine agenesis with no evidence of uterine tissue (arrow).
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Figure 26a. MR images of obstructed transverse vaginal septum. (a) Coronal fast spin-echo T2-weighted (6500/120) and (b) sagittal fast spin-echo T2-weighted (7150/105) images show thin transverse vaginal septum (arrow in a) resulting in severe hematocolpos (arrow in b) and milder hematometra.
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Figure 26b. MR images of obstructed transverse vaginal septum. (a) Coronal fast spin-echo T2-weighted (6500/120) and (b) sagittal fast spin-echo T2-weighted (7150/105) images show thin transverse vaginal septum (arrow in a) resulting in severe hematocolpos (arrow in b) and milder hematometra.
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Figure 27a. MR images of complex anomaly with obstruction. (a) Transverse fast spin-echo T2-weighted (7400/105) and (b) coronal fast spin-echo T2-weighted (7150/100) images show bicornuate configuration of uterine horns, with a lower uterine-cervical septum (straight arrow in a) extending to the vagina and with a right transverse vaginal septum resulting in hematometrocolpos (straight arrow in b). Note solid mass in right ovary (curved arrow), which was found at laparotomy to be a dysgerminoma.
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Figure 27b. MR images of complex anomaly with obstruction. (a) Transverse fast spin-echo T2-weighted (7400/105) and (b) coronal fast spin-echo T2-weighted (7150/100) images show bicornuate configuration of uterine horns, with a lower uterine-cervical septum (straight arrow in a) extending to the vagina and with a right transverse vaginal septum resulting in hematometrocolpos (straight arrow in b). Note solid mass in right ovary (curved arrow), which was found at laparotomy to be a dysgerminoma.
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Copyright © 2004 by the Radiological Society of North America.
