Comparison of the junctional zone thickness and perfusion between fertile and infertile woman on magnetic resonance imaging

Abstract

Introduction: We compared in a prospective study the uterine junctional zone thickness and perfusion between nullipara, primipara and infertile women on MRI in order to predict infertility using these non-evasive MRI features of the junctional zone. Materials and Methods: We examined 63 women during their menstrual cycle (mean age 27,66 years, nullipara: 13 without and 22 with contraception, primipara(MRI examination performed between 3 and 12 months after delivery): 1 without and 7 with contraception and 20 infertile women with ovulation) on a 1.5T Siemens Symphony TIM-upgraded with contrast administration (gadolinium at a flow rate of 3ml/sec). The junctional zone thickness and perfusion were measured at three different locations (fundus midcorpus and isthmus) in the anterior and posterior wall of the uterus. These measurements were compared with the uterine volume, total myometrium thickness respectively of the anterior and posterior wall, menstrual cycle, age and use of contraceptives of the women. Two researchers (one radiologist and one student) performed the measurements double-blinded. A κ analysis was performed for the inter- and intra-observer measurements. Results: As expected, there was a significant difference in the junctional zone thickness between nullipara taking contraceptives and the one without. The latter show a junctional zone thickness of at least one third of the wall thickness, not exceeding half the wall thickness. These similar findings were repeated in the primipara women. Our statistic analysis pointed out that the best moment and location to measure the junctional thickness was during the follicular phase (between day 7 and 13) and in the posterior uterine wall namely at the fundus and isthmus. However there was no significant difference in junctional zone thickness between fertile and our subtype of infertile women. Besides the junctional zone thickness we evaluated the junctional zone perfusion, more specific the contrast enhancement kinetics within the first minute after gadolinium administration. It showed a statistically significant difference between the follicular phase and luteal phase, also between nullipara with and without taking contraceptives. But so far our infertile subtype data was too small to compare them with the other women(which we are still working on). Conclusion: Our data revealed no statistically significant difference between nullipara without contraception, primipara and our subtype of infertile women. However the junctional zone perfusion kinetics during the follicular phase showed a promising difference and may in the future (a larger study groupe) reveal one answer in our subtype of infertile women.