Niche role of MRI in the evaluation of female infertility

Abstract

Infertility is a major social and clinical problem affecting 13–15% of couples worldwide. The pelvic causes of female infertility are categorized as ovarian disorders, tubal, peritubal disorders, and uterine disorders. Appropriate selection of an imaging modality is essential to accurately diagnose the aetiology of infertlity, since the imaging diagnosis directs the appropriate treatment to be instituted. Imaging evaluation begins with hystero- salpingography (HSG), to evaluate fallopian tube patency. Uterine filling defects and contour abnormalities may be discovered at HSG but usually require further characterization with pelvic ultrasound (US), sono-hysterography (syn: hystero-sonography/saline infusion sonography) or pelvic magnetic resonance imaging (MRI), when US remains inconclusive. The major limitation of hysterographic US, is its inability to visualize extraluminal pathologies, which are better evaluated by pelvic US and MRI. Although pelvic US is a valuable modality in diagnosing entities comprising the garden variety, however, extensive pelvic inflammatory disease, complex tubo-ovarian pathologies, deep-seated endometriosis deposits with its related complications, Mulllerian duct anomalies, uterine synechiae and adenomyosis, often remain unresolved by both transabdominal and transvaginal US. Thus, MRI comes to the rescue and has a niche role in resolving complex adnexal masses, endometriosis, and Mullerian duct anomalies with greater ease. This is a review, based on the authors’ experience at tertiary care teaching hospitals and aims to provide an imaging approach towards the abnormalities which are not definitively diagnosed by ultrasound alone.

Diagnostic role of magnetic resonance hysterosalpingography in the evaluation of female infertility

“…3 Department of Urology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India. 4 Department of Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India. 5 Department of Obstertrics and Gynecology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India.…”

“…In the era of evidence-based medicine, MRI has an indispensable role in the diagnosis and management of female infertility. MRI increases the diagnostic performance of transvaginal sonography in the accurate detection of extensive pelvic inflammation, complex tubo ovarian pathologies, leiomyomas, exact delineation of endometriosis and adenomyosis [4] The need to assess tubal patency has been addressed by increasing literature for utilization of gadolinium (Gd) in MRI and comparing it with HSG alone or a mixture of HSG and laparoscopy [5][6][7][8][9][10][11].…”

Acute pelvic pain: A pictorial review with magnetic resonance imaging

“…It is manifested as a syndrome of dull lower abdominal pain, abnormal discharge, dyspareunia, fever, and elevated leukocyte counts. [ 17 ] The most common organisms identified in PID are Chlamydia trachomatis and Neisseria gonorrhoeae. [ 18 ] Other less common organisms include mycoplasma (14% of cases) and Gram-negative rods.…”

“…MRI has a sensitivity, specificity, and diagnostic accuracy of 95%, 89%, and 93% in diagnosing the PID. [ 17 ]…”

Tubo-ovarian Abscess and Uterine Leiomyoma in a 35-year-old woman with 8 years of infertility: A Case Report

“…The causes of infertility in women can be due to ovarian, tubal, peritubal and uterine abnormalities. 1 Uterine leiomyoma is the most common benign uterine tumor found in the lower abdomen and affects women in reproductive age. Leiomyomas can be found in 30-40% of all women between the ages of 30 -40 and are often seen in African women compared to women of other ethnicities.…”