An integrated imaging approach for diagnosis of cervico-vaginal outflow defects and associated genital anomalies

The objective of this study was to evaluate the diagnosis of cervico-vaginal outflow anomalies using different ultrasound approaches (transabdominal, endoluminal and transperineal) and magnetic resonance imaging. Thirty female patients, their age ranged from 11 to 42years (mean age 14.4, +/6.9 s/d) with clinically suspected cervico-vaginal outflow defects presented with amenorrhea, dysparunia or cyclic abdominal pain. They were subjected to ultrasound and MR imaging examinations. Imaging results were correlated with clinical examination and surgery. The study included 10/30 cases of aplasia/hypoplasia (33.3%), 4/30 cases of imperforate hymen (13.3%), 6/30 cases of transverse vaginal septum (20%), 4/30 cases of vaginal atresia (13.3%), 3/30 cases of combined cervical/vaginal atresia (10%), 1/30 case of cervical stenosis (3.3%), 1/30 case of cervical atresia (3.3%), and 1/30 case of vaginal atresia with fistula (urogenital sinus syndrome) (3.3%). Obstructed outflow was detected in 17 patients (56.6%). The accuracy of multi-approach US and MRI examinations in diagnosis of cervico-vaginal outflow anomalies was 94.1% and 97.1% respectively. Ultrasound examination using different approaches remains the initial investigation for all patients with simple müllerian anomalies. MRI examination could be reserved for more complex anomalies, long cervicovaginal atresia and for cases of urogenital sinus syndrome.