I-42: MRI Evaluation of Congenital Uterine Anomalies

Mullerian duct anomalies are an uncommon but often treatable cause of infertility. Patients with müllerian duct anomalies are known to have a higher incidence of infertility, repeated first-trimester spontaneous abortions, fetal intrauterine growth retardation, fetal malposition, preterm labor, and retained placenta. The role of imaging is to help detect, diagnose, and distinguish surgically correctable forms of müllerian duct anomalies from inoperable forms (see the images below). In some correctable lesions, the surgical approach is altered based on imaging findings. MRI of the uterus (in benign conditions such as congenital anomalies or fibroid evaluation) is performed following administration of 1.0 mg IM of glucagon to decrease motion artifacts associated with bowel peristalsis. For the diagnosis of most anomalies, 5 main sequences are sufficient: • Coronal single-shot fast spin-echo (FSE) images of the ureters and pelvis provide good localized and survey views of ureters. • Axial T1 spin-echo (without fat-saturation pulse) images. • Sagittal T2 FSE (without fat-saturation pulse) images. Fat signal is useful to delineate pelvic structures. • Oblique long-axis T2 FSE (without fat-saturation pulse) images. This plane is ideal for visualization of the uterine cavity and uterine fundal contour. • Oblique short-axis T2 FSE (without fat-saturation pulse) images are perpendicular to the long axis and sagittal planes (usually oblique axial), providing short-axis (target) views of the uterine cavity useful for visualizing a transverse septum if present