Comparing the Diagnostic Efficacy of 3D Ultrasound and MRI in the Classification of Müllerian Anomalies

Müllerian anomalies significantly impact female reproductive health. This study aims to compare the diagnostic efficacy of three-dimensional ultrasound (3D-US) and magnetic resonance imaging (MRI) in detecting and classifying these anomalies.

A retrospective analysis of 150 patients with Müllerian anomalies was conducted at Saveetha Medical College and Hospital from March 2018 to March 2024. MRI and 3D-US examinations were performed and analyzed independently by two radiologists. Anomalies were classified according to European Society of Human Reproduction and Embryology (ESHRE)/European Society for Gynaecological Endoscopy (ESGE) and American Society for Reproductive Medicine (ASRM) guidelines.

The septate uterus was the most prevalent anomaly, observed in 53 patients (35.3%). MRI demonstrated superior diagnostic accuracy (AUC 0.92) compared to 3D-US (AUC 0.88). Significant associations were found between presenting symptoms and specific anomaly types (p < 0.05). Inter-rater reliability between the two radiologists, with respect to classification of anomalies, was high (Cohen's kappa 0.85).

MRI's superior soft-tissue contrast and multiplanar capabilities make it the gold standard for evaluating complex uterine malformations. 3D-US offers valuable real-time imaging and is particularly effective in assessing septum characteristics. The combined use of MRI and 3D-US enhances diagnostic precision and facilitates tailored management strategies.

Integrating MRI and 3D-US in clinical practice improves diagnostic accuracy and treatment planning for Müllerian anomalies, ultimately enhancing patient outcomes.