Letterie G S, Haggerty M, Lindee G
Department of Obstetrics and Gynecology, Virginia Mason Medical Center, Seattle, Washington, USA.
Int J Fertil Menopausal Stud. 1995 Jan-Feb;40(1):34-8.
The purpose of the present study was to compare prospectively the accuracy of pelvic US examination and MR imaging in the assessment of müllerian tract abnormalities.
Sixteen patients with congenital müllerian defects underwent US examination, MR imaging, diagnostic laparoscopy, and hysteroscopy. Abnormalities included unicornuate (n = 2), bicornuate (n = 6), and septate (n = 6) uteri, and normal uteri with septate vagina (n = 2). Patients with müllerian abnormalities were referred after hysterosalpingogram or clinical examination revealed uterine, cervical, and/or vaginal congenital abnormalities. Laparoscopic and hysteroscopic confirmation of these radiologic impressions was made in all patients.
Pelvic US examination and MR imaging for all abnormalities had an overall sensitivity of 57% and 77%, specificity of 50% and 33%, a positive predictive value of 89% and 83%, and a negative predictive value of 14% and 25%, respectively. Pelvic US examination and MR imaging correctly diagnosed septate uterus in 2/6 cases (33%) and 3/6 cases (50%), respectively. This abnormality was most commonly misdiagnosed as a normal or bicornuate uterine cavity. For bicornuate uterus, pelvic US and MR, however, correctly diagnosed 6/6 cases (100%) and 5/6 cases (83%), respectively. Accurate diagnoses were made for bicornuate uteri using either modality owing mainly to the presence of a characteristic fundal notch. US examination was nonspecific for unicornuate uterus (0/2 cases diagnosed), defining only a single cavity, but without sufficient details of adnexal regions. MR imaging of unicornuate uteri, however, provided detailed images of both uterine cavity configuration (2/2 cases diagnosed) and adnexal anatomy.
Our data suggest that pelvic US examination and MR imaging are not sufficiently accurate to qualify as sole diagnostic studies for septate uteri. Though less expensive and less invasive than diagnostic laparoscopy, they do not provide a sufficiently sensitive and specific method to differentiate septate from bicornuate uteri, a critical aspect for surgical planning. Though more costly, diagnostic laparoscopy appears to be the most accurate diagnostic study for the assessment of uterine anatomy and definition of müllerian abnormalities.
本研究的目的是前瞻性比较盆腔超声检查和磁共振成像在评估苗勒管异常方面的准确性。
16例先天性苗勒管缺陷患者接受了超声检查、磁共振成像、诊断性腹腔镜检查和宫腔镜检查。异常情况包括单角子宫（n = 2）、双角子宫（n = 6）和纵隔子宫（n = 6），以及伴有纵隔阴道的正常子宫（n = 2）。苗勒管异常患者在子宫输卵管造影或临床检查发现子宫、宫颈和/或阴道先天性异常后前来就诊。所有患者均通过腹腔镜和宫腔镜检查对这些影像学表现进行了确认。
盆腔超声检查和磁共振成像对所有异常情况的总体敏感性分别为57%和77%，特异性分别为50%和33%，阳性预测值分别为89%和83%，阴性预测值分别为14%和25%。盆腔超声检查和磁共振成像分别在2/6例（33%）和3/6例（50%）中正确诊断出纵隔子宫。这种异常最常被误诊为正常或双角子宫腔。然而，对于双角子宫，盆腔超声和磁共振成像分别正确诊断出6/6例（100%）和5/6例（83%）。由于存在特征性的宫底切迹，两种检查方法对双角子宫均能做出准确诊断。超声检查对单角子宫不具有特异性（0/2例诊断），仅显示单个宫腔，但对附件区域的细节显示不足。然而，单角子宫的磁共振成像提供了子宫腔形态（2/2例诊断）和附件解剖结构的详细图像。
我们的数据表明，盆腔超声检查和磁共振成像作为纵隔子宫的唯一诊断性检查不够准确。虽然它们比诊断性腹腔镜检查成本更低、侵入性更小，但它们没有提供一种足够敏感和特异的方法来区分纵隔子宫和双角子宫，而这对于手术规划至关重要。虽然成本更高，但诊断性腹腔镜检查似乎是评估子宫解剖结构和明确苗勒管异常最准确的诊断性检查。
