Magnetic resonance imaging of uterovaginal lesions associated with female infertility

Objective: To study the mandatory indications and accuracy of magnetic resonance (MR) imaging for the diagnosis of uterovaginal lesions associated with female infertility. Design: Prospective cross sectional study. Main outcome measures: Indications and accuracy of MR imaging for the diagnosis of uterovaginal lesions. Materials and methods: 423 infertile women were investigated by hysterosalpingography (HSG) and transvaginal ultrasonography (TVUS). In 54 women having uterovaginal lesions and 76 women with tubo-ovarian lesions, the diagnosis was not conclusive by HSG and TVUS and consequently they were examined by MR imaging. The present study was devoted for infertile women suffering from uterovaginal lesions. Results: MR imaging confirmed the diagnosis of agenesis of the uterus and the vagina (1 case), unicornuate uterus (2 cases, functioning rudimentary horn connected to the dominant horn in 1 case), uterus didelphys (1 case), bicornuate uterus (5 cases), septate and subseptate uteri (10 cases). Eighteen patients had multiple corporeal leiomyomas, 8 subserous and 10 intramural, diffuse adenomyosis, 14 cases and localized adenomyoma, 3 cases. Intramural leiomyomas showed enhancement on T2-weighted imaging suggesting a good response to uterine artery embolization (UAE). The size, number and location of myomas were precisely demonstrated on MR imaging, information necessary for myomectomy and UAE. The findings of MR imaging were compared with the final diagnosis after laparoscopy or surgical intervention and histopathological study. The accuracy, sensitivity, specificity, and positive and negative predictive values of MR imaging for diagnosing uterovaginal lesions associated with infertility were 100%. Conclusion: The present study proved that MR imaging was the method of choice for precise diagnosis of uterovaginal lesions associated with infertility, when the diagnosis was not conclusive on HSG and TVUS. MR imaging was mandatory for conclusive diagnosis of mullerian duct anomalies, adenomyosis uteri and multiple uterine leiomyomas destined to myomectomy or uterine artery embolization. The accuracy, sensitivity, specificity and positive and negative predictive values of MR imaging for diagnosis of these lesions were 100%