OC16.06: A 10‐year review of the magnetic resonance imaging and clinical features of Mayer‐Rokitansky‐Küster‐Hauser syndrome

Mayer-Rokitansky-Küster–Hauser (MRKH) syndrome is a congenital disorder characterised by uterine and vaginal hypoplasia. Magnetic resonance imaging (MRI) is the gold standard for diagnosis. Imaging features of MRKH have been correlated with surgical findings, but clinical implications are less understood. We aim to correlate the imaging findings with clinical history to understand the association between morphology and functionality of uterine anlage. Women referred to a specialist service with a diagnosis of MRKH who had an MRI pelvis between 1st January 2011 – 31st April 2021 were included. Outcomes were predefined. Images were analysed by specialist gynecological radiologists. Clinical data was extracted from an electronic patient record system. 136 patients were included. Half (49.6%) of women presenting had a history of pain, most often abdominal (86.4%) or vaginal (10.6%). 47.7% reported cyclical pain, 40% variable and 10% dyspareunia. Anlage were identified in 93.3% of women (n = 126). There was visible endometrium in 12.6% and a fibrous band in 94.1%. Ovaries were present in 97.1%. The mean anlage volume was 4.45cm3 on the right and 4.78 cm3 on the left. Ovaries were ectopically positioned in 38.5%. Renal and vertebral anomalies were present in 33.1% and 16.2% respectively. 4.6% of women had imaging features of endometriosis. Women with pain were significantly more likely to have a functional anlage compared to those without (34.9% vs 10.8%, p = 0.001). Pain was not strongly associated with ectopic ovary position on MRI. Common gynecological pathology such as ovarian cysts and fibroids were also seen. This is the largest retrospective review of MRI features of MRKH to date. We identify that majority of women with MRKH will have uterine anlage with a connecting fibrous band, with an ectopic ovarian position in many cases. Pain is a common issue and is significantly associated with a functional anlage on MRI. Further work is required to identify how other gynecological pathology impacts these women.