苗勒氏管畸形的影像学诊断北京协和医院

Imaging of Mullerian Duct Anomalies北京协和医院北京协和医院放射科放射科 陆菁菁陆菁菁 M.D.M.D.MDA介绍介绍lFusion of the Mullerian ducts:the 6th to the 11th weeks of gestationlThe uterus,fallopian tubes,cervix,and proximal two-thirds of the vaginalNot associated with anomalies of the external genitalia or ovarian developmentl15%women who experience recurrent miscarriageslCommonly associated with renal agenesis(30%-50%)lOther associated congenital anomalies:vertebral bodies,spina bifida,cardiac,et al女性生殖管道的发生女性生殖管道的发生 中肾管中肾管 退化退化中肾旁管中肾旁管 输卵管输卵管 子宫管子宫管 子宫，阴道上部子宫，阴道上部窦结节窦结节 阴道板阴道板 空腔化空腔化 阴道下部阴道下部 Ductal development Ductal fusion Septal reabsorptionPrevalence of MDAl5.5%in general populationl13-25%among women with recurrent pregnancy losslGeneral population:larcuate uterus,3.9%lBicornuate uterus,0.4%lWomen with infertility or miscarriage:lSeptate uterus,15.4%Imaging OverviewlHSG:uterine cavitylUS,MRI:lGreater anatomic detaillExternal uterine contourlConcomitant renal anomaliesHSG难以区分子宫纵隔难以区分子宫纵隔 vs 双角子宫双角子宫What is this?磁共振在女性盆腔应用的优势磁共振在女性盆腔应用的优势l无放射性损伤无放射性损伤l优于超声优于超声:软组织分辨力高软组织分辨力高l优于超声优于超声:扫描范围广扫描范围广l优于超声优于超声:磁共振成像图像直观，便于手术大夫理解和参考磁共振成像图像直观，便于手术大夫理解和参考l超声超声:对单角子宫及始基子宫诊断有限度对单角子宫及始基子宫诊断有限度MRI sequenceslAxial T1-and T2-weighted imageslOblique coronal T2-weighted images of the uterusl3D T2-weightedlSagittal,T2-weighted 脂肪抑制脂肪抑制T2加权横断面图像加权横断面图像 T2加权正中矢状面像加权正中矢状面像（尤其适合子宫走向、宫颈及阴道的观察）（尤其适合子宫走向、宫颈及阴道的观察）T1加权横断面像加权横断面像ClassificationAgenesis or HypoplasiaUnicornuate UterusUnicornuate Uterus双子宫（双子宫（Uterus Didelphys）Uterus DidelphysRepresentative line diagram depicting right renal agenesis,uterine didelphys,and vaginal septumHerlyn-Werner-Wunderlich(HWW)syndrome Bicornuate UterusSeptate UterusArcuate uterusDES Uterus复杂畸形复杂畸形完全型纵隔子宫合并双宫颈管（罕见）完全型纵隔子宫合并双宫颈管（罕见）。