Mullerian duct anomalies: MR imaging

Mullerian duct anomalies (MDAs) are rare, affecting approximately 1% of all women and about 3% of women with poor reproductive outcomes. These congenital anomalies usually result from one of the following categories of abnormalities of the mullerian ducts: failure of formation (no development or underdevelopment) or failure of fusion of the mullerian ducts. The American Fertility Society (AFS) classification of uterine anomalies is widely accepted and includes seven distinct categories. MR imaging has consolidated its role as the imaging modality of choice in the evaluation of MDA. MRI is capable of demonstrating the anatomy of the female genital tract remarkably well and is able to provide detailed images of the intra-uterine zonal anatomy, delineate the external fundal contour of the uterus, and comprehensively image the entire female pelvis in multiple imaging planes in a single examination. The purpose of this pictorial essay is to show the value of MRI in the diagnosis of MDA and to review the key imaging features of anomalies of formation and fusion, emphasizing the relevance of accurate diagnosis before therapeutic intervention.