Magnetic resonance imaging for diagnosis of pelvic lesions associated with female infertility

Objective: To study the mandatory indications and accuracy of magnetic resonance (MR) imaging for diagnosis of pelvic lesions associated with female infertility.Design: Prospective cross-sectional study.Main outcome measures: Indications and accuracy of MR imaging for diagnosis of pelvic lesions. Uterovaginal lesions were excluded as they were studied in a previous article (under publication).Materials and methods: 423 infertile women were investigated by hysterosalpingography (HSG), transabdominal and transvaginal ultrasonography after thorough clinical examination. Hundred and thirty (30.95%) patients were associated with pelvic lesions not conclusively diagnosed by HSG or/and ultrasonography and were examined by MR imaging to confirm the diagnosis. Fifty-four patients (41.53%) had uterovaginal lesions. They were discussed in a previous article. Seventy-six (58.46%) patients had other pelvic lesions. The present study concerned with these lesions.Results: The diagnosis by MR imaging was conclusive for 11 cases of pyosalpinx, 3 cases of hematosalpinx, 25 cases of hydrosalpinx, 24 cases of ovarian endometriomas, deep endometriosis of the of rectosigmoid (3 cases), urinary bladder (3 cases), one case of endometriosis of the abdominal wall after repeated cesarean sections and six ovarian tumors, 5 cases of benign cystic teratoma and 1 case of serous cystadenocarcinoma. The diagnosis of these lesions was confirmed by laparoscopy or laparotomy and histopathological examination. Magnetic resonance imaging failed to diagnose peritubal adhesions in 22 out of 39 cases (56.41%) of tubal lesions and peritoneal implants of endometriosis in 12 out of 31cases (38.70%) of pelvic endometriotic lesions. They were discovered during the surgical treatment of the tubal and ovarian lesions through laparoscopy or laparotomy.Conclusion: The following pelvic lesions associated with female infertility were not conclusively diagnosed by HSG or/ and US but were precisely diagnosed by MR imaging with 100% accuracy: Pyosalpinx, hydrosalpinx and hematosalpinx, ovarian and deep infiltrating endometriosis and benign and malignant ovarian tumors as benign cystic teratoma and serous cystadenocarcinoma