Magnetic resonance imaging (MRI) and clinical features of Mayer-Rokitansky-Küster–Hauser (MRKH) syndrome: a 10-year review from a dedicated specialist centre

Objective: to correlate the clinical history with imaging findings of women with MRKH Design: Retrospective cohort study Setting: A UK IOTA and ESGO-certified tertiary referral centre for disorders of reproductive development Population: All patients with a diagnosis of MRKH and had undergone an MRI pelvis between 1st January 2011 – 31st April 2021 were included Method: MRI images were analysed by specialist gynaecological radiologists. Clinical data was extracted from an electronic patient record system. Statistical analysis was computed in R (version 4.1.2), R base stats package and ggstatsplot (v0.5.0). Outcome measures: clinical history and predefined imaging features Results: 134 patients were included. Median age at MRI was 18 years (10 – 64 years). Half (48.2%) of women presenting had a history of pain, most often abdominal (84.6%) or vaginal (9.2%). Anlage were identified in 91.8% of women (n = 123). 4.5% of women had imaging features of endometriosis (n = 6). Women with a functional anlage were significantly more likely to experience pain (p <0.001). Pain history was not strongly associated with ectopic ovarian position. Common gynaecological pathology such as endometriosis, ovarian cysts and fibroids were also identified. Conclusions: We identify that majority of women with MRKH will have uterine anlage with a connecting fibrous band, and an ectopic ovarian position 44.0% of cases. Abdominal pain was significantly associated with functional anlage on MRI. Further work is required to identify how other gynaecological pathology impacts women with MRKH.