A Comparison of MRI and Laparoscopy in Detecting Pelvic Structures in Cases of Vaginal Agenesis

Objective: To determine whether laparoscopy improves detection of uterine structures over MRI in cases of vaginal agenesis. Design: Prospective case series. Setting: Ambulatory pediatric gynecology clinic in a tertiary care childrenʹs hospital. Participants: Subjects with vaginal agenesis who had an MRI to detect uterine structures. Main Outcome Measures: A chart review identified subjects with vaginal agenesis who had an MRI to assess müllerian structures. The MRI findings were correlated with physical exam, presenting symptoms, and operative findings. We assessed degree of agreement between laparoscopy and MRI in patients both with and without pelvic pain to determine sensitivity and specificity of MRI in predicting uterine structures confirmed on laparoscopy. Results: Twenty-two subjects with vaginal agenesis were identified and 14 had both an MRI and laparoscopic evaluation. MRI successfully predicted uterine anomalies in six cases (43%) and lack of uterine structures in one case (8%). MRI diagnosis did not correlate with laparoscopic findings in the remaining seven cases (50%). Among subjects presenting with no complaints of pelvic pain (n = 6), three had negative MR imaging but positive laparoscopy. Using laparoscopy as a gold standard, MRI had a sensitivity of 53% for accurately detecting uterine anomalies confirmed on laparoscopy. Conclusion: Laparoscopy improves detection of uterine structures over MRI alone in women with vaginal agenesis.