Magnetic Resonance Imaging Evaluation of Müllerian Duct Anomalies According to the New ASRM 2021 Classification

Abstract

Background: Mullerian duct anomalies (MDAs) are common and affect the reproductive health of women. They have a prevalence of 5.5% to 7.0%  in the general population, up to 13.0% in women with a history of miscarriage, and up to 24.5% in women with a history of both infertility and miscarriage Müllerian anomalies might involve agenesis, dysplasia, non-fusion or abnormal septation of the fallopian tubes, uterus, cervix or upper vagina in any combination. Additionally, cervical or vaginal atresia or septation can occur with or without associated uterine abnormalities. MRI is best for delineating the morphology and orientation of pelvic structures. Though it is noninvasive and radiation-free, it has limited availability and high cost, it is contraindicated in patients with cardiac pacemakers and cochlear implants.

Aim: The aim of the study is improving delineation, diagnosis and classification of Müllerian duct anomalies using magnetic resonance imaging with its multi-planar reformatting according to the new ASRM classification.

Conclusion: MRI is a highly accurate, reproducible, and non-invasive imaging modality for the assessment of Müllerian duct anomalies. The updated ASRM 2021 classification system provides a practical and comprehensive framework for categorizing a broad spectrum of anomalies. Therefore, MRI should be considered the imaging modality of choice for the diagnosis and classification of Müllerian duct anomalies and for guiding appropriate clinical and reproductive management.