Comparison of MR pelvic imaging classification of mullerian duct anomaly in primary amenorrhea

Mullerian duct anomaly (MDA) causes clinical manifestations depending on the level and severity of the abnormality. Magnetic resonance imaging is the modality of choice for diagnosing anatomical abnormality of the Mullerian organ. The variability of the anomaly leads to the need of a classification for better management and treatment. This study compared the most used classification of Mullerian Duct Anomaly. Two female organ radiology consultants retrospectively reviewed pelvic MRIs of 52 female patients with MDA from 2018 to 2022. Mullerian and female anatomy structures were reported based on the classification of the American Society for Reproductive Medicine (ASRM) and the European Society of Human Reproduction and Embryology (ESHRE). We compared and measured the interobserver agreements of both categories with Cohen’s kappa and interclass agreements. From the cross table of the uterus morphology, both classification showed similar normal and abnormal uterus conditions, including aplasia and agenesis. There are different results on bicorporeal complete and didelphys with k= 0,898 (P 0,001). The interobserver agreement of ASRM result then measured with Kappa with result 0.960 (P 0.001). In the ESHRE-ESGE classification, agreement is divided according to each class, uterus, cervix, and vagina with each Kappa values ​​of 0.905, 0.903 and 0.760, respectively, and p-value 0.001. Fifty-two of our subjects were 6(11.5%) with endometrioma, 6(11.5%) with kidney abnormality, and 1(1.9%) with spine abnormality. ASRM and ESHRE classification are reliable in describing features of MDA despite the need for additional elaboration of concomitant abnormalities for the importance of treatment.