Congenital Obstructive Mullerian Anomaly: The Pitfalls of a Magnetic Resonance Imaging-Based Diagnosis and the Importance of Intraoperative Biopsy

A retrospective cohort study of the concordance between the magnetic resonance imaging (MRI) diagnosis and final diagnosis in patients with Mullerian duct anomalies (MDAs) was conducted, and diagnostic clues were suggested. A total of 463 cases of young women who underwent pelvic MRIs from January 1995 to February 2019 at Seoul Asan Medical Center were reviewed. Interventions consisted of clinical examinations, abdominal or transvaginal/rectal ultrasound, MRI, and operative procedures, including hysteroscopy and laparoscopy. The concordance of the diagnosis between the results obtained with MRI and those obtained with surgeries was evaluated. It was found that a total of 225 cases (48.6%) showed genital tract anomalies on MRI. Among them, 105 cases (46.7%) underwent reconstructive surgery. Nineteen cases (8.4%) revealed discrepancies between the final diagnosis after surgery and the initial MRI findings and eleven cases (57.9%) had cervical anomalies. Incorrect findings associated with the MRIs were particularly evident in biopsied cases of cervical dysgenesis. A combination of physical examination, ultrasound, and MRI is suitable for preoperative work-up in the diagnoses of congenital obstructive anomalies. However, it is recommended that a pathologic confirmation of tissue at the caudal leading edge be made in obstructive genital anomalies, in cases of presumptive vaginal or cervical dysgenesis.