الفهرس 
ryology Anatomy and emb of female genital systemOnly 14 pages are availabe for public view
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Abstract
Müllerian duct anomalies encompass a wide spectrum of clinical and imaging findings, and while many of the anomalies will be diagnosed initially at HSG or two-dimensional US, further imaging with MR and, potentially, three-dimensional US will often be required for a definitive diagnosis.
Hysterosalpingography is indicated in the early stages of evaluation of the infertile couple. The examination provides a morphologic assessment of the endometrial and endocervical canals and supplies important information regarding tubal patency. Characterization of uterine anomalies can be difficult, however, and there can be considerable overlap in findings, notably with regard to differentiation of a septate from a bicornuate uterus . The major limitations of the procedure are the ability to characterize only patent canals and the inability to evaluate the external uterine contour adequately. HSG also entails exposure to ionizing radiation in these typically young women.
Transabdominal US is usually best performed with a curved 4–1-MHz or 6–3-MHz transducer, although US is
operator dependent and may be limited because of the patient’s body habitus, the uterine lie, and shadowing from peristaltic bowel loops.
Endovaginal US has the advantage of improved spatial resolution, however, the number of scanning planes available with a transvaginal probe is finite because of the constraints of the pelvic anatomy.
Although this is of little consequence when assessing acquired uterine abnormalities, it is a major limiting factor in the diagnosis of congenital uterine anomalies as the diagnosis of congenital uterine anomalies requires the assessment of both the internal and external contour of the uterine fundus and conventional methods of assessing uterine morphology do not allow visualization of this plane, also neither of them enable the uterine fundus to be evaluated accurately, so that it is often necessary to proceed to more invasive investigations such as a combined hysteroscopy and laparoscopy to make a diagnosis. However, these are invasive procedures, and their use remains limited to women who have poor reproductive histories in whom a congenital uterine anomaly is suspected.
US has a reported pooled accuracy of approximately 90%–92%.
The advent of high-resolution transvaginal three-dimensional ultrasound in gynaecology has enabled many of these limitations to be overcome. It has enabled the accurate, non-invasive, outpatient diagnosis of congenital uterine anomalies and large-scale screening and morphological analysis of congenital uterine anomalies. The three-dimensional ultrasound volume may be examined in an infinite number of planes by manipulating the volume and obtaining an image through the desired plane. Thus, it is possible with three-dimensional ultrasound to visualize the uterus in the coronal plane with the internal and external contours of the fundus visible on one image. It is also possible to measure uterine dimensions and thereby not only quantify the morphological defect but also evaluate the likely success of any surgical intervention.
Hysterosonography has been widely used more recently to detect uterine cavity abnormalities. It is used to differentiate septate from bicornuate uterus with 100% accuracy.
Recently, some authors suggested that 3D sonohysterography provides a more precise evaluation of the
intrauterine cavity. In fact, the addition of a coronal plane allows a better delineation of the uterus as the three planes can be visualized simultaneously. This seems to be the most promising imaging technique for uterine malformation detection, but not every infertility clinic is equipped with a 3D ultrasound machine.
MR imaging currently is the study of choice with its multiplanar capabilities and high soft-tissue resolution. MR imaging helps identify the morphology of uterovaginal anomalies and aids in their classification and treatment. Imaging parallel to the long axis of the uterus is especially useful for visualizing the external contour of the uterine fundus. Accurate MR evaluation of uterine septum extension and composition is crucial in the treatment of double uteri. MR imaging can determine the level of obstruction in obstructive uterovaginal anomalies, which is important for surgical planning. Recent advances in the technology of MR imaging allow its use as a problem-solving tool in the diagnosis of uterovaginal anomalies. Laparoscopy and hysteroscopy are then reserved for women in whom interventional therapy is being undertaken, thus reducing
health care expenditures and sparing women invasive diagnostic procedures.
In conclusion, although MRI is now the study of choice to diagnose Mullerian duct anomalies with its high resolution and multiplanar capabilities, but recently some authors suggest that other procedures like transvaginal 3D ultrasonography or transvaginal 3D sonohysterography are also very promising imaging techniques for uterine malformation detection.