Plicae palmatae of the cervical canal visualized on MRI

Plicae palmatae on MRI in the pediatric population

PURPOSE

To examine the presence of ridge of plicae palmatae (RPP) in pediatric population and evaluate its depiction rate and appearance on magnetic resonance imaging (MRI).

MATERIALS AND METHODS

Consecutive pelvic MRI examinations of female patients aged 0-19 years between January 2005 and April 2017 were retrospectively reviewed. Patients with underlying diseases affecting the uterus and whose MRI data were not available on the picture archiving and communication system were excluded. Thus, 171 pelvic MRI cases were included (mean patient age, 11 years). Morphologic appearance of RPP was evaluated. RPP depiction rate was evaluated in the following age groups: group A, 0-2 years; B, 3-6 years; C, 7-10 years; and D, 11-19 years. Pearson Chi square test or Fisher's exact test was used to assess statistical significance of differences in RPP visualization frequencies between the groups using SPSS for Windows, version 11.0.0.1 J. Statistical significance was set at P < 0.05.

RESULTS

RPP appeared as a folded structure rather than tumorous in all cases. Depiction rate varied according to age: group A, 8/21 (38.1%); B, 0/16 (0%); C, 6/24 (25.0%); and D, 62/110 (56.4%). Depiction rate in group B was the lowest and significantly lower than those in groups A and D. However, RPP was most frequently observed in group D, and was significantly more frequent than in groups B and C.

CONCLUSION

RPP could be observed on MRI in a pediatric population, and careful interpretation is necessary in such cases, although no case with tumorous appearance was observed. Depiction rate varies according to age, probably reflecting uterine maturity.

Plicae palmatae in neonates: tumor mimic on sonography

Plicae palmatae are uterine cervical folds that can be misdiagnosed as a uterine septum on magnetic resonance imaging (MRI). Previous studies in the literature generally tend to include only adults and are limited to MRI findings. Here, we present the case of a 6-day-old girl with a tumorous lesion in her uterine isthmus on sonography. Although we considered uterine tumor as a differential diagnosis, the smooth surface and continuity with a cervical fold on the caudal side suggested that the lesion was, in fact, the tip of plicae palmatae. MRI was subsequently performed, and no restricted diffusion was found, which was useful in ruling out a malignant tumor. Our case highlights that plicae palmatae in neonates can mimic a tumor on sonography. Meticulous observation of a continuity with a cervical fold is essential for correct diagnosis.

Plicae palmatae: an anatomical uterine cervix variation to be considered on magnetic resonance images

OBJECTIVE

The aim of this study was to research the frequency and distribution of plicae palmatae in women in different age groups.

METHODS

Data of 409 female patients' magnetic resonance images were evaluated.

RESULTS

We found a frequency of plicae palmatae variations in the study population of 44.5%. It was statistically most frequent in the fourth decade. The presence of plicae palmatae variations in the period after menopause was significantly lower than that during the reproductive period.

CONCLUSIONS

Identification of plicae palmatae may be misdiagnosed as uterine septum and more awareness of this situation is required to prevent unnecessary surgery.

Double cervix: clarifying a diagnostic dilemma

OBJECTIVE

Although double cervix is often considered to indicate uterus didelphys, it may be challenging to determine the true associated anomaly as double cervix occurs with other müllerian anomalies. Our purpose is to report the frequency of uterine müllerian anomalies that occur with a double cervix and identify imaging or clinical criteria to help classify the associated anomaly.

STUDY DESIGN

After institutional review board approval, an electronic search was performed to identify patients with double cervix and pelvic magnetic resonance imaging (MRI) between 1976-2010 (using International Statistical Classification of Diseases and Related Health Problems, Edition 9 and Hospital International Classification of Diseases Adapted codes). MRIs were reviewed to classify the müllerian anomaly. Clinical characteristics including cervical canal thickness, intercervical distance and orientation were recorded. Kruskal-Wallis and χ(2) tests were used to test for differences in patient and imaging characteristics across müllerian anomalies.

RESULTS

There were 64 patients who met inclusion criteria: 32 (50%) septate uterus, 27 (42%) uterus didelphys and 5 (8%) bicornuate uterus. Cervical canal divergence was present in 34% (11/32) with septate uterus, 26% (7/27) with uterus didelphys, and none with bicornuate uterus. Mean intercervical distance was significantly greater (P < .001) in uterus didelphys (12.05 mm) compared with septate (5.43 mm) or bicornuate uterus (5.40 mm).

CONCLUSION

Septate uterus is as common as uterus didelphys, and considerably more common than bicornuate uterus, in women with a double cervix. Although a widened intercervical distance may support the MRI diagnosis of uterus didelphys, careful evaluation of the uterine fundus is required for correct diagnosis when encountering a double cervix.

Plicae palmatae of the cervical canals in uterus didelphys: MR imaging

The plicae palmatae are normal endocervical folds on the anterior and posterior walls. The median longitudinal ridges of the plicae palmatae have been considered to represent a remnant of fused Müllerian ducts. We present a case of uterus didelphys in which the longitudinal ridge of the plicae palmatae were obviously demonstrated on both of the uterine cervices on axial T2-weighted image. The observation of the plicae palmatae on the duplicated uterine cervices indicates the plicae palmatae is an inherent structure of the cervical canal, not a remnant of fused Müllerian duct.