The objective of this study was to highlight the importance of magnetic resonance imaging (MRI) in achieving an accurate early diagnosis and facilitating precise treatment planning for Müllerian duct anomalies (MDAs). To discuss this topic, we present two case reports.

Case 1: a 19-year-old nulliparous female presented with primary amenorrhea and normal secondary sexual characteristics. Vaginal inspection revealed a shortened vagina, but no discernible cervix. Transvaginal ultrasound (US) subsequently showed an oval structure initially thought to be the cervix, but no visible uterus or ovaries. MRI eventually confirmed a diagnosis of Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome, with an absence of a uterus, cervix and upper section of the vagina, and the presence of a median fibrous remnant. Case 2: a 24-year-old nulliparous female presented with severe dysmenorrhea and uterine tenderness upon physical examination. Initial US evaluation pointed to bilateral hydrosalpinx. Pelvic MRI finally confirmed a left unicornuate uterus with a rudimentary non-communicating right cavity and associated hematosalpinx. The patient underwent surgical removal of the right rudimentary horn and fallopian tube.

These cases demonstrate how MRI yields a much more detailed evaluation of the anatomy of the pelvic region. Early diagnosis and appropriate treatment can significantly reduce the risk of complications and enhance outcomes.