Agreement between the Radiological Diagnosis of Mullerian Duct Anomalies on 3 Tesla MRI and Clinical Diagnosis TC01-TC05
Dr. Adarsh Kibballi Madhukeshwar,
Assistant Professor, Department of Radiodiagnosis, Yenepoya Medical College, Mangaluru-575018, Karnataka, India.
Introduction: Mullerian Duct Anomalies (MDAs) are developmental abnormalities of paramesonephric ducts. MDAs usually present with reproductive issues.
Aim: To determine the agreement between the Magnetic Resonance Imaging (MRI) findings of MDAs with clinical diagnosis. Materials and Methods: Retrospective observational study was done where the MRI abdomen and pelvis imaged using 3 Tesla (T) MRI during the period of two years (May 2018 till April 2020) were reviewed. The American Society for Reproductive Medicine classification was used for classifying MDAs. Clinical details (clinical symptoms, findings from pelvic examination, imaging modalities other than MRI, surgeries/procedures like laparoscopy, laparotomy, hysteroscopy, etc) were obtained by reviewing the case records and agreement between radiological and clinical diagnosis was observed using Kappa statistics.
Results: Out of 1,054 female MRIs of abdomen and pelvis screened during the study period about 36 patients were found to have MDAs. Thirty six MRIs were included for the final analysis and three were excluded because of no consensus in diagnosis. Prevalence of MDA was 3.13% and mean age of the study participants was 24.76 (Â±5.52) years. The minimum and maximum ages were 15 years and 36 years respectively. Most common symptom of MDAs was repeated miscarriage (36.36%) followed by dysmenorrhea (30.30%). For evaluation of the uterus, there was agreement in 27 out of 33 patients and disagreement in 6 out of 33. Reporting was done by two radiologists. The radiological diagnosis was made first and the cases with MDAs were checked for clinical diagnosis. Excellent agreement was observed between the radiological and clinical diagnosis with kappa value of 0.80. Retrospective image analysis was done to specify the disagreements and the causes were found to be lack of specific criterion for conditions like arcuate uterus, presence of associated complex and less known pathological conditions and not acquiring thinner volume sections in certain cases having thin septa.
Conclusion: Among female patients who were diagnosed with MDAs, excellent agreement was observed between the radiological and clinical diagnosis. Few pitfalls were noted which needs to be addressed while making a diagnosis of MDAs in MRI.