MRI image features and differential diagnoses of Herlyn–Werner–Wunderlich syndrome

Abstract

This study aims to explore how Herlyn–Werner–Wunderlich Syndrome (HWWS) manifests in diagnostic images and analyze the imaging specifications and differential diagnoses thus improving the understanding of the disease. The preoperative magnetic resonance imaging (MRI) findings and clinical data of 19 patients with HWWS were retrospectively analyzed, taking the intraoperative findings and postoperative pathological results of laparoscopic or hysteroscopy surgery as the diagnostic criteria. In this study, all the 19 patients underwent laparoscopic or hysteroscopic excision of vaginal oblique septum, and the preoperative MRI diagnosis of HWSS was consistent with the clinical postoperative diagnosis, with a diagnosis coincidence rate of 19/19 (100%). According to the classification of vaginal oblique septum syndrome, 16 cases were vaginal oblique septum type I and 3 cases were vaginal oblique septum type II. MRI showed a double uterus and double cervix, blood accumulation and dilatation of the vagina connected with the cervix of the affected side, T1WI showed high signal intensity and T2WI showed low or mixed signal intensity. MRI coronal view of 19 patients clearly showed ipsilateral renal absence with obstruction, including 5 cases on the left and 14 cases on the right. Other pelvic complications included: 1 patient with cervical dysplasia and the absence of right kidney and ureter, 3 patients with right ovarian endometriosis cyst, 1 patient with complicated with adenomyosis, 1 patient with right ovarian follicular cyst, 1 patient with right ovarian fallopian tube and pelvic abscess, and 1 patient with right ovarian hematoma. The MRI image of HWWS has its own features and MRI can more accurately evaluate type and related complications of HWWS, therefore it can be used as the best and effective examination method for preoperative imaging evaluation, thus better providing help for clinical comprehensive preoperative evaluation and guidance of surgery.

摘要

本研究旨在探讨Herlyn-Werner-Wunderlich综合征（HWWS）在影像学诊断中的表现, 并分析影像学特征和鉴别诊断, 提高对该病的认识。回顾性分析19例HWWS患者术前MRI表现及临床资料, 以腹腔镜或宫腔镜手术中表现及术后病理结果为诊断标准。本研究纳入19例患者均行腹腔镜或宫腔镜下阴道斜隔切除术, 术前MRI诊断HWSS与术后临床诊断一致, 诊断符合率为19/19（100%）。按照阴道斜隔综合征的分型, 16例为阴道斜隔I型, 3例为阴道斜隔II型。MRI示双子宫双宫颈, 阴道积血扩张与受累侧宫颈相连, T1W1信号强, T2W1低信号或混杂信号。19例患者MRI冠状面清晰显示同侧肾缺如伴梗阻, 其中左侧5例, 右侧14例。其他盆腔并发症包括：1患者宫颈发育不良和右肾及输尿管缺乏, 1例卵巢血肿。HWWS的MRI图像有其自身的特点, MRI能更准确地评价HWWS的类型及相关并发症, 是术前影像学评价的最佳、有效的检查方法, 更好地为临床术前评价及指导提供帮助。

The Chinese abstracts are translated by Prof. Dr. Xiangyan Ruan and her team: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.

Keywords:

• Herlyn–Werner–Wunderlich syndrome
• types
• magnetic resonance imaging (MRI)
• differential diagnosis

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This research was supported by Lanzhou science and technology planning project, Gansu, China (project number: 2018-3-29) and Lanzhou science and technology planning project, Gansu, China (project number: 2018-3-53).