苗勒氏管畸形的影像学诊断 北京协和医院

Imaging of Mullerian Duct Anomalies

北京协和医院 放射科 陆菁菁 M.D.

MDA介绍

Fusion of the Mullerian ducts: the 6th to the 11th weeks of gestation The uterus, fallopian tubes, cervix, and proximal twothirds of the vagina Not associated with anomalies of the external genitalia or ovarian development 15% women who experience recurrent miscarriages Commonly associated with renal agenesis(30%-50%) Other associated congenital anomalies: vertebral bodies, spina bifida, cardiac, et al

女性生殖管道的发生

中肾管 → 退化

中肾旁管 → 输卵管 子宫管 → 子宫，阴道上部 Ductal development Ductal fusion Septal reabsorption

窦结节 → 阴道板 → 空腔化 → 阴道下部

Prevalence of MDA

5.5% in general population 13-25% among women with recurrent pregnancy loss

General population:

arcuate uterus, 3.9% Bicornuate uterus, 0.4% Septate uterus, 15.4%

Women with infertility or miscarriage:

Imaging Overview

HSG: uterine cavity

US, MRI:

Greater anatomic detail External uterine contour Concomitant renal anomalies

HSG难以区分子宫纵隔 vs 双角子宫

What is this?

磁共振在女性盆腔应用的优势

无放射性损伤 优于超声: 软组织分辨力高 优于超声: 扫描范围广 优于超声: 磁共振成像图像直观，便于手术大夫理解和参考 超声: 对单角子宫及始基子宫诊断有限度

MRI sequences

Axial T1- and T2- weighted images Oblique coronal T2- weighted images of the uterus 3D T2-weighted Sagittal, T2-weighted

脂肪抑制T2加权横断面图像

T2加权正中矢状面像

（尤其适合子宫走向、宫颈及阴道的观察）

T1加权横断面像

Classification

Agenesis or Hypoplasia

Unicornuate Uterus

Unicornuate Uterus