Preibsch H, Rall K, Wietek B M, Brucker S Y, Staebler A, Claussen C D, Siegmann-Luz K C
Department of Radiology, Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
Eur Radiol. 2014 Jul;24(7):1621-7. doi: 10.1007/s00330-014-3156-3. Epub 2014 Apr 16.
The aim of this study was to evaluate the accuracy of preoperative magnetic resonance imaging (MRI) in the diagnosis of malformations associated with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome and identification of uterine endometrium to optimise the clinical management.
We retrospectively reviewed 214 consecutive MRKH patients, mean age 19 years, who underwent laparoscopy-assisted neovagina creation. A total of 115 patients (53.7%) met the inclusion criterion of sufficient preoperative MRI. In 110 of them (95.7%), MRI findings were correlated with laparoscopy and associated malformations. In 39 cases (35.5%) uterine rudiments were removed and analysed histopathologically.
Ten per cent (11/110) of the patients showed complete uterine agenesis. The others presented with either unilateral (n = 16; 14.5%) or bilateral (n = 83; 75.5%) uterine rudiments. MRI detection of uterine rudiments agreed in 78.2% (86/110) with laparoscopy. In 85.4% of the removed rudiments, MRI could correctly diagnose the existence of the endometrium. Compared to laparoscopy, MRI could exactly detect ovaries in 97.3% (107/110). Renal or ureteral malformations were seen in 32 cases (27.8%). In 83% of unilateral renal agenesis and unilateral rudiment, the latter was located at the side of the kidney.
MRI is useful for preoperative detection of MRKH-associated malformations and assessment of the endometrium to further optimise MRKH patient treatment.
• Pelvic MRI is useful for preoperative detection of MRKH-associated malformations. • MRI can diagnose uterine endometrium in MRKH patients with high precision. • Preoperative MRI can optimise clinical management of patients with MRKH syndrome.
本研究旨在评估术前磁共振成像（MRI）在诊断与 Mayer-Rokitansky-Küster-Hauser（MRKH）综合征相关的畸形以及识别子宫内膜方面的准确性，以优化临床管理。
我们回顾性分析了 214 例连续接受腹腔镜辅助新阴道成形术的 MRKH 患者，平均年龄 19 岁。共有 115 例患者（53.7%）符合术前 MRI 充分的纳入标准。其中 110 例（95.7%）患者的 MRI 结果与腹腔镜检查及相关畸形进行了对比。39 例（35.5%）患者的子宫残件被切除并进行了组织病理学分析。
10%（11/110）的患者表现为子宫完全缺如。其他患者表现为单侧（n = 16；14.5%）或双侧（n = 83；75.5%）子宫残件。MRI 对子宫残件的检测与腹腔镜检查的一致性为 78.2%（86/110）。在 85.4%的切除残件中，MRI 能够正确诊断子宫内膜的存在。与腹腔镜检查相比，MRI 能在 97.3%（107/110）的患者中准确检测到卵巢。32 例（27.8%）患者存在肾脏或输尿管畸形。在 83%的单侧肾缺如和单侧子宫残件病例中，后者位于肾脏同侧。
MRI 有助于术前检测与 MRKH 相关的畸形并评估子宫内膜，从而进一步优化 MRKH 患者治疗。
• 盆腔 MRI 有助于术前检测与 MRKH 相关的畸形。• MRI 能高精度诊断 MRKH 患者的子宫内膜。• 术前 MRI 可优化 MRKH 综合征患者的临床管理。
