Magnetic Resonance Imaging (MRI) in Primary Amenorrhea: A Comprehensive Analysis

Ramsha Fatima Qureshi, Sadaf Nasir, Rabiya Siraj, Ayesha Shayan^*, Uzma Panhwer, Rabia Ahmed Siddiqui
Department of Radiology, Liaquat National Hospital, Karachi, Pakistan.

Correspondence to: Ayesha Shayan, Department of Radiology, Liaquat National Hospital, Karachi, Pakistan.
Received date: January 24, 2025; Accepted date: February 24, 2025; Published date: March 03, 2025
Citation: Qureshi RF, Nasir S, Siraj R, et al. Magnetic Resonance Imaging (MRI) in Primary Amenorrhea: A Comprehensive Analysis J Med Res Surg. 2025;6(2):22-26. doi: 10.52916/jmrs254161
Copyright: ©2025 Qureshi RF, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.

Abstract

Objective: This study aims to investigate the frequency and underlying causes of primary amenorrhea utilizing MRI as a diagnostic tool.
Material and Methods: Cross sectional prospective study was conducted at Department of Radiology, Liaquat National Hospital, Karachi for 1.5 years. However, sample size was limited due to very low prevalence.
The uterus was examined in terms of normal growth and developmental abnormalities, such as rudimentary uterus, agenesis and hypoplasia. The ovaries were evaluated in terms of normal development, location anomalies, agenesis, presence of ovotestis and hypoplasia. Patients with ovarian tissue showing normal, hypoplastic, unilateral agenesis or location anomalies were examined for Müllerian duct anomalies. The cause of primary amenorrhea was detected using pelvic MRI as per operational definition.
Results: In our study, a total of 14 patients were included who presented with complaints of primary amenorrhea. Out of these, 5 were diagnosed on mri as gonadal dysgenesis and 7 were diagnosed with mullerian duct abnormalities. While 2 were diagnosed with male pseudohermaphroditism and imperforate hymen.
Among those who were diagnosed with gonadal dysgenesis, about 4 had sawyer syndrome while about 1 had ovarian hypoplasia. Among patients who had mullerian duct abonrmalities, about 5 had Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome which was the overall most common anomaly observed in our study.
Conclusion: In conclusion, MRI is a useful modality that aids in early diagnosis of primary amenorrhea which helps in early intervention and surgical correction requiring multidisciplinary approach so as to aid in puberty, fertility and psychological care of the patient.

Keywords:

Magnetic Resonance Imaging (MRI), Primary amenorrhea, Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, Mullerian Duct Anomalies (MDAS)

References

1. Kriplani A, Goyal M, Kachhawa G, et al. Etiology and management of primary amenorrhoea: A study of 102 cases at tertiary centre. Taiwan J Obstet Gynecol. 2017;56(6):761-764.
2. Deligeoroglou E, Athanasopoulos N, Tsimaris P, et al. Evaluation and management of adolescent amenorrhea. Ann N Y Acad Sci. 2010;1205:23-32.
3. Geckinli BB, Toksoy G, Sayar C, et al. Prevalence of X-aneuploidies, X-structural abnormalities and 46,XY sex reversal in Turkish women with primary amenorrhea or premature ovarian insufficiency. Eur J Obstet Gynecol Reprod Biol. 2014;182:211-215.
4. Tanmahasamut P, Rattanachaiyanont M, Dangrat C, et al. Causes of primary amenorrhea: a report of 295 cases in Thailand. J Obstet Gynaecol Res. 2012;38(1):297-301.
5. Behr SC, Courtier JL, Qayyum A. Imaging of müllerian duct anomalies. Radiographics. 2012;32(6):E233-E250.
6. Rosenberg HK. Sonography of the pelvis in patients with primary amenorrhea. Endocrinol Metab Clin North Am. 2009;38(4):739-760.
7. Al Jurayyan NA, Al-Jurayyan RN, Mohamed SH, et al. Radiological imaging of disorders of sex development (DSD). Sudan J Paediatr. 2013;13(2):10-16.
8. Klein DA, Poth MA. Amenorrhea: an approach to diagnosis and management. Am Fam Physician. 2013;87(11):781-788.
9. Çakmak V, Karabulut N, Çakmak P, et al. The efficiency of magnetic resonance imaging in the diagnosis of primary amenorrhea. Pamukkale Med J. 2008;1:132-136.
10. Azidah A, Nik Hazlina N, Aishah M. Swyer syndrome in a woman with pure 46, XY gonadal dysgenesis and a hypoplastic uterus. Malays Fam Physician. 2013;8(2):58-61.
11. Mannaerts D, Muys J, Blaumeiser B, et al. A rare cause of primary amenorrhoea, the XY female with gonadal dysgenesis. BMJ Case Rep. 2015;2015:bcr2014206609.
12. Berberoğlu M, Şıklar Z; Ankara University Dsd Ethic Committee. The Evaluation of Cases with Y-Chromosome Gonadal Dysgenesis: Clinical Experience over 18 Years. J Clin Res Pediatr Endocrinol. 2018;10(1):30-37.
13. Gündoğdu E, Emekli E, Oğuzman M, et al. Evaluation of the abdominopelvic region using MRI in patients with primary amenorrhea. J Pediatr Endocrinol Metab. 2019;32(9):995-1003.
14. Yadav P. Magnetic resonance imaging in the evaluation of female pelvis. Med J DY Patil Univ. 2016;9(5):627-634.
15. Brenner C, de Bruyn R. Imaging of benign paediatric gynaecological disorders. Imaging. 2003;15(2):53-62.
16. Mueller GC, Hussain HK, Smith YR, et al. Müllerian duct anomalies: comparison of MRI diagnosis and clinical diagnosis. AJR Am J Roentgenol. 2007;189(6):1294-1302.
17. Wagner BJ, Woodward PJ. Magnetic resonance evaluation of congenital uterine anomalies. Semin Ultrasound CT MR. 1994;15(1):4-17.