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Licensed Unlicensed Requires Authentication Published by De Gruyter August 1, 2019

Evaluation of the abdominopelvic region using MRI in patients with primary amenorrhea

  • Elif Gündoğdu ORCID logo EMAIL logo , Emre Emekli ORCID logo , Mehmet Oğuzman ORCID logo and Mahmut Kebapçı ORCID logo

Abstract

Background

This study aimed to evaluate the imaging findings of patients who underwent an abdominal and pelvic magnetic resonance imaging (MRI) due to primary amenorrhea.

Methods

The pelvic and abdominal images of 34 female patients (mean age 15.61 years, range 14–19 years) were retrospectively analyzed by a single radiologist blinded to the clinical and laboratory data of the patients (other than primary amenorrhea) to evaluate the etiology of primary amenorrhea. The anatomy and anomalies of the internal genital organs and other accompanying abdominopelvic anomalies were investigated.

Results

Gonadal dysgenesis was present in 14 patients (41.17%) and Müllerian duct anomalies (MDAs) were present in 20 (58.83%) (Mayer-Rokitansky-Kuster-Hauser [MRKH] syndrome in 13 [65%], distal vaginal obstruction [DVO] findings in five [25%], and obstructed hemivagina and ipsilateral renal anomaly [OHVIRA] syndrome in two [10%]). Seven patients with MRKH (53.84%) were of type 1 and six (46.15%) were of type 2. A total of eight additional anomalies (vertebral and renal) were detected, six in MRKH and two in OHVIRA syndrome cases. Endometrioma and hematosalpinx were observed in one of the five patients with DVO (5%).

Conclusions

Primary amenorrhea is a common symptom that affects both the physical and psychosocial status of individuals. Determination of the underlying etiology is the first step in planning treatment. The evaluation of internal genital organ anomalies involved in the etiology is important for sexual function and fertility. MRI is a non-invasive imaging modality that should be preferred in these cases as it provides detailed data about the anatomy and anomalies of internal genital organs due to its high soft tissue contrast resolution.


Corresponding author: Asst. Prof. Elif Gündoğdu, Eskisehir Osmangazi University, Faculty of Medicine, Department of Radiology, Odunpazarı, 26480 Eskişehir, Turkey, Phone: +90 222 229 3979, Fax: +90 222 229 1418

Acknowledgments

None declared.

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data.

References

1. Kriplani A, Goyal M, Kachhawa G, Mahey R, Kulshrestha V. Etiology and management of primary amenorrhoea: a study of 102 cases at tertiary centre. Taiwan J Obstet Gynecol 2017;56:761–4.10.1016/j.tjog.2017.10.010Search in Google Scholar

2. Deligeoroglou E, Athanasopoulos N, Tsimaris P, Dimopoulos KD, Vrachnis N, et al. Evaluation and management of adolescent amenorrhea. Ann N Y Acad Sci 2010;1205:23–32.10.1111/j.1749-6632.2010.05669.xSearch in Google Scholar PubMed

3. Geckinli BB, Toksoy G, Sayar C, Soylemez MA, Yesil G, et al. Prevalence of X-aneuploidies, X-structural abnormalities and 46,XY sex reversal in Turkish women with primary amenorrhea or premature ovarian insufficiency. Eur J Obstet Gynecol Reprod Biol 2014;182:211–5.10.1016/j.ejogrb.2014.09.033Search in Google Scholar PubMed

4. Tanmahasamut P, Rattanachaiyanont M, Dangrat C, Indhavivadhana S, Angsuwattana S, et al. Causes of primary amenorrhea: a report of 295 cases in Thailand. J Obstet Gynaecol Res 2012;38:297–301.10.1111/j.1447-0756.2011.01677.xSearch in Google Scholar PubMed

5. Behr SC, Courtier JL, Qayyum A. Imaging of müllerian duct anomalies. Radiographics 2012;32:E233–50.10.1148/rg.326125515Search in Google Scholar PubMed

6. Rosenberg HK. Sonography of the pelvis in patients with primary amenorrhea. Endocrinol Metab Clin North Am 2009;38:739–60.10.1016/j.ecl.2009.09.002Search in Google Scholar PubMed

7. Al Jurayyan NA, Al-Jurayyan RN, Mohamed SH, Babiker AM, Al Otaibi HM. Radiological imaging of disorders of sex development (DSD). Sudan J Paediatr 2013;13:10–6.Search in Google Scholar PubMed

8. Klein DA, Poth MA. Amenorrhea: an approach to diagnosis and management. Am Fam Physician 2013;87:781–8.Search in Google Scholar PubMed

9. Reindollar RH, Tho SP, McDonough PG. Delayed puberty: an update study of 326 patients. Trans Am Gynecol Obstet Soc 1989;8:146–62.Search in Google Scholar

10. Reindollar RH, Byrd JR, McDonough PG. Delayed sexual development: a study of 252 patients. Am J Obstet Gynecol 1981;140:371–80.10.1016/0002-9378(81)90029-6Search in Google Scholar PubMed

11. Çakmak V, Karabulut N, Çakmak P, Özarı N, Kıroğlu Y. The efficiency of magnetic resonance imaging in the diagnosis of primary amenorrhea. Pamukkale Med J 2008;1:132–6.Search in Google Scholar

12. Azidah A, Nik Hazlina N, Aishah M. Swyer syndrome in a woman with pure 46, XY gonadal dysgenesis and a hypoplastic uterus. Malays Fam Physician 2013;8:58–61.Search in Google Scholar

13. Mannaerts D, Muys J, Blaumeiser B, Jacquemyn Y. A rare cause of primary amenorrhoea, the XY female with gonadal dysgenesis. BMJ Case Rep 2015;2015:bcr2014206609.10.1136/bcr-2014-206609Search in Google Scholar PubMed PubMed Central

14. Berberoğlu M, Şıklar Z, Ankara University Dsd Ethic Committee. The evaluation of cases with Y-chromosome gonadal dysgenesis: clinical experience over 18 years. J Clin Res Pediatr Endocrinol 2018;10:30–7.10.4274/jcrpe.4826Search in Google Scholar PubMed PubMed Central

15. Maggio MC, De Pietro A, Porcelli P, Serraino F, Angileri T, et al. The predictive role of pelvic magnetic resonance in the follow up of spontaneous or induced puberty in turner syndrome. Ital J Pediatr 2018;44:24.10.1186/s13052-018-0458-0Search in Google Scholar PubMed PubMed Central

16. Hall-Craggs MA, Williams CE, Pattison SH, Kirkham AP, Creighton SM. Mayer-Rokitansky-Kuster-Hauser syndrome: diagnosis with MR imaging. Radiology 2013;269:787–92.10.1148/radiol.13130211Search in Google Scholar PubMed

17. Giusti S, Fruzzetti E, Perini D, Fruzzetti F, Giusti P, et al. Diagnosis of a variant of Mayer-Rokitansky-Kuster-Hauser syndrome: useful MRI findings. Abdom Imaging 2011;36:753–5.10.1007/s00261-011-9732-ySearch in Google Scholar PubMed

18. Fiaschetti V, Taglieri A, Gisone V, Coco I, Simonetti G. Mayer-Rokitansky-Kuster-Hauser syndrome diagnosed by magnetic resonance imaging. Role of imaging to identify and evaluate the uncommon variation in development of the female genital tract. J Radiol Case Rep 2012;6:17–24.10.3941/jrcr.v6i4.992Search in Google Scholar PubMed

19. Rousset P, Raudrant D, Peyron N, Buy JN, Valette PJ, et al. Ultrasonography and MRI features of the Mayer-Rokitansky-Küster-Hauser syndrome. Clin Radiol 2013;68:945–52.10.1016/j.crad.2013.04.005Search in Google Scholar PubMed

20. Kara T, Acu B, Beyhan M, Gökçe E. MRI in the diagnosis of Mayer-Rokitansky-Kuster-Hauser syndrome. Diagn Interv Radiol 2013;19:227–32.Search in Google Scholar

21. Boruah DK, Sanyal S, Gogoi BB, Mahanta K, Prakash A, et al. Spectrum of MRI appearance of Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome in primary amenorrhea patients. J Clin Diagn Res 2017;11:30–5.10.7860/JCDR/2017/29016.10317Search in Google Scholar

22. Pompili G, Munari A, Franceschelli G, Flor N, Meroni R, et al. Magnetic resonance imaging in the preoperative assessment of Mayer-Rokitansky-Kuster-Hauser syndrome. Radiol Med 2009;114:811–26.10.1007/s11547-009-0407-5Search in Google Scholar PubMed

23. Economy KE, Barnewolt C, Laufer MR. A comparison of MRI and laparoscopy in detecting pelvic structures in cases of vaginal agenesis. J Pediatr Adolesc Gynecol 2002;15:101–4.10.1016/S1083-3188(02)00136-5Search in Google Scholar PubMed

24. Yoo RE, Cho JY, Kim SY, Kim SH. A systematic approach to the magnetic resonance imaging-based differential diagnosis of congenital Müllerian duct anomalies and their mimics. Abdom Imaging 2015;40:192–206.10.1007/s00261-014-0195-9Search in Google Scholar PubMed

25. Angotti R, Molinaro F, Bulotta AL, Bindi E, Cerchia E, et al. Herlyn-Werner-Wunderlich syndrome: an “early” onset case report and review of Literature. Int J Surg Case Rep 2015;11:59–63.10.1016/j.ijscr.2015.04.027Search in Google Scholar PubMed PubMed Central

26. Reinhold C, Hricak H, Forstner R, Ascher SM, Bret PM, et al. Primary amenorrhea: evaluation with MR imaging. Radiology 1997;203:383–90.10.1148/radiology.203.2.9114092Search in Google Scholar PubMed

27. Fedele L, Dorta M, Brioschi D, Guidci M, Villa L. Magnetic resonance imaging of unicornuate uterus. Acta Obstet Gynecol Scand 1990;69:511–3.10.3109/00016349009013328Search in Google Scholar PubMed

Received: 2019-01-29
Accepted: 2019-06-17
Published Online: 2019-08-01
Published in Print: 2019-09-25

© 2019 Walter de Gruyter GmbH, Berlin/Boston

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