苗勒氏管畸形的影像学诊断北京协和医院

ImagingofMullerianDuctAnomalies北京协和医院放射科陆菁菁M.D.MDA介绍FusionoftheMullerianducts:the6thtothe11thweeksofgestationTheuterus,fallopiantubes,cervix,andproximaltwo-thirdsofthevaginaNotassociatedwithanomaliesoftheexternalgenitaliaorovariandevelopment15%womenwhoexperiencerecurrentmiscarriagesCommonlyassociatedwithrenalagenesis(30%-50%)Otherassociatedcongenitalanomalies:vertebralbodies,spinabifida,cardiac,etal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，阴道上部窦结节→阴道板→空腔化→阴道下部•Ductaldevelopment•Ductalfusion•SeptalreabsorptionPrevalenceofMDA5.5%ingeneralpopulation13-25%amongwomenwithrecurrentpregnancylossGeneralpopulation:arcuateuterus,3.9%Bicornuateuterus,0.4%Womenwithinfertilityormiscarriage:Septateuterus,15.4%ImagingOverviewHSG:uterinecavityUS,MRI:GreateranatomicdetailExternaluterinecontourConcomitantrenalanomaliesHSG难以区分子宫纵隔vs双角子宫Whatisthis?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MRIsequencesAxialT1-andT2-weightedimagesObliquecoronalT2-weightedimagesoftheuterus3DT2-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ClassificationAgenesisorHypoplasiaUnicornuateUterusUnicornuateUterus双子宫（UterusDidelphys）UterusDidelphysRepresentativelinediagramdepictingrightrenalagenesis,uterinedidelphys,andvaginalseptumHerlyn-Werner-Wunderlich(HWW)syndromeBicornuateUterusSeptateUterusArcuateuterusDESUterus复杂畸形完全型纵隔子宫合并双宫颈管（罕见）