Magnetic resonance imaging of classified and unclassified Müllerian duct anomalies: Comparison of the American Society for Reproductive Medicine and the European Society of Human Reproduction and Embryology classifications

Abstract

Magnetic resonance imaging (MRI), due to its optimal delineation of anatomy, has become the mainstay in imaging for diagnosing Müllerian duct anomalies (MDA). Pelvic MRI is requested for various conditions such as primary amenorrhoea, infertility or poor obstetric history with regard to MDA, as identifying the exact aetiology for these conditions is vital. Knowledge regarding the classification of MDA is important, as the treatment varies with respect to the different classes. As all the lesions do not fit within the classification of the American Society for Reproductive Medicine, a new anatomy-based classification was established by the European Society of Human Reproduction and Embryology and the European Society for Gynecological Endoscopy, to fulfil the needs of experts. We aim to discuss various classes of classified and unclassified MDA with regard to both the above-mentioned classifications and illustrate some of them using various cases based on pelvic MRI studies.

A Case Report on Communicating Left Unicornuate Uterus and Right Rudimentary Horn With Hematometra and Hematosalpinx

“…Recently, in a study conducted by Jayasinghe et al [8], 376 cases were reviewed, which were based on rudimentary horns, wherein they found that the majority of patients (78%) did not show any symptoms and were first appearing in the third decade of life. After menarche, women frequently reported abdominal pain or progressive dysmenorrhea, which was presumed to be due to endometriosis, hematosalpinx, and hematometra [6,8]. In this case, a left unicornuate uterus with a propagating rudimentary horn on the right side was associated with hematometra as well as hematosalpinx.…”

“…Pregnancy issues include malpresentation, frequent abortion, and premature labor, and women might also present with infertility. Early diagnosis is therefore crucial, but it is challenging because patients may remain asymptomatic [4,6,8]. However, in this case, the patient was symptomatic and reported early, leading to effective management.…”

“…The American Society for Reproductive Medicine (ASRM) has given a classification of Müllerian duct abnormalities in which class II comprises the unicornuate uterus. This has been further divided into four sets of subdivisions wherein communicating is considered in II A, noncommunicating in II B, no cavity in II C, and no horn in II D [5,6]. In this presented case, the rudimentary horn's cavity was functional and communicating with the uterus; hence, it would be categorized as class II A.…”

“…However, appropriate diagnosis prior to surgical intervention is crucial for preventing future complications. The laparoscopic technique has been described in several cases, and this method seems to be effective because it is safe and efficient for the removal of rudimentary horns [6]. Laparoscopic approaches are advantageous because these procedures are minimally invasive, thus eliminating the need for prolonged hospital stays, providing faster recovery, along with better cosmetic outcomes when compared with similar results of laparotomy [7].…”

Successful Management of a Noncommunicating Rudimentary Uterine Horn Pregnancy by Laparoscopic Surgery

“…[ 10 43 ] Magnetic resonance imaging (MRI) seems to be particularly important for performing a prompt and correct diagnosis before laparoscopic treatment. [ 56 ] However, a large review, which collected RHPs in the 20 th century, found that in 6.5% of all RHP cases, patients could obtain live newborn babies. [ 5 ] In addition, in the 21 st century, there are some cases in which patients could achieve live newborn babies by cesarean section,[ 11 23 26 35 44 57 58 59 60 61 62 63 64 ] although those situations may be extremely rare in the current developed countries.…”