August 2nd, 2021

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Novel Use of Organ Segmentation Via Cancer Imaging Software in the Visualization of Complex Müllerian Anomalies: A Case Report
Authors:  Jennifer J. Chae-Kim, M.D., Rasha Makkia, Ph.D., Clifford C. Hayslip, Jr., M.D., and Keith H. Nelson, M.D.
BACKGROUND: Müllerian duct anomalies are complex congenital malformations of the female genital tract, which may be associated with renal or urologic abnormalities. Preoperative planning for surgical management often includes multiple imagining modalities, and a multidisciplinary approach is typically pursued for optimal outcomes.

CASE: A 12-year-old female presented with dysmenorrhea and enuresis. On imaging she was found to have a didelphys uterus with suspected noncommunicating right uterine horn with hematometra, and right renal agenesis. Magnetic resonance imaging suggested possible ectopic ureter; however, she was diagnosed with a right ureterocele on urethrocystogram. During laparoscopic resection of the right uterine horn, dark blood was unexpectedly discovered in the urinary catheter. Cystoscopy revealed extrusion of dark blood from the right ureteral orifice, previously unrecognized on cystoscopy at the beginning of the case. In light of the intraoperative findings, retrospective review of the case was undertaken. Images from preoperative planning were reconstructed by way of organ segmentation using Velocity, a cancer imaging software, to reveal an anastomotic connection between the right uterine horn and an ectopic ureteral remnant.

CONCLUSION: Cancer imaging software can be used to integrate various imaging modalities in a novel method of visualizing complex Müllerian anatomy, which may improve preoperative planning for surgical management.
Keywords:  cancer imaging, diagnostic imaging, ectopic ureter, Mullerian anomalies, radiation planning, Velocity
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