Use of MRI for diagnosis of congenital vaginal anomalies and concordance with clinical and surgical findings: A study from the Queensland Paediatric and Adolescent Gynaecology Service

Abstract

Introduction Magnetic Resonance Imaging (MRI) is the diagnostic imaging gold standard for anomalies of the female reproductive tract. At our institution, MRI is used to facilitate diagnosis in all cases of suspected congenital anomalies, and our data on concordance with diagnosis demonstrates accuracy of uterine anomalies as 94%, cervical anomalies 88%, and vaginal anomalies 78%, with all structure concordance of 69%. More detailed analysis of vaginal, with or without associated cervical and/or uterine anomalies was done, with an aim to identify the accuracy of MRI, establish diagnostic criteria and highlight potential limitations in the diagnosis and management of vaginal anomalies. Methods A retrospective audit was performed of all patients with vaginal anomalies seen by the PAG service who had an MRI. Data including demographics, MRI diagnosis, and clinical, surgical and histological findings, was collected from patient records. Results There were 102 patients with anomalies of the reproductive tract, of which 54 patients had vaginal anomalies. In 8 patients that had isolated vaginal anomalies, one had congenital vaginal narrowing, two had lower vaginal atresia, 4 had transverse vaginal septa, and one had a longitudinal vaginal septum. The concordance between MRI and surgical findings in cases of isolated vaginal anomalies was 6/8 (75%). Two patients were found to have complete vaginal atresia, with partial cervical atresia, and 1 of the 2 were concordant on MRI for the vaginal anomaly, and 0 of 2 were concordant for the cervical atresia. Forty four patients had vaginal anomalies with uterine anomalies (with or without cervical anomalies), of which 14 patients had the OHVIRA didelphys triad, 22 had MRKH and 8 had other various complex anomalies. In this group, there was 35/44 (80%) on MRI for the vaginal anomaly, and 40/44 (91%) concordance for the uterine anomaly. Conclusion Understanding the anatomy and accurate preoperative diagnosis assists with preoperative planning, counselling the patient and family, and consent. MRI concordance for vaginal anomalies is less than that for cervical or uterine anomalies. It would appear from our data that MRI concordance for vaginal atresia and transverse vaginal septa has the least accuracy, and absent vagina (MRKH) and longitudinal vaginal septa the highest. MRI accuracy for vaginal delineation has evolved at our institution with improved radiological techniques and close collaboration with the multi-disciplinary team of paediatric gynaecologists and radiologists in providing review and feedback after the full surgical picture has been determined.L6215698632018-04-11 <br />