Role of transperineal ultrasound compared to pelvic magnetic resonance imaging in assessment of vaginal abnormalities

Abstract Background Ultrasound (US), including transvaginal ultrasound (TVUS), transperineal ultrasound (TPUS), and the pelviabdominal ultrasound (PAUS) with two-dimensional (2D) and three-dimensional (3D) reformatted images, is the first-line tool in the assessment of different vaginal abnormalities. Magnetic resonance imaging (MRI) is recommended when findings are inconclusive due to its superior soft-tissue details. This study aimed to validate the role of TPUS in the assessment of females’ vaginal abnormalities at different ages. Methods This cross-sectional analytic investigation included 32 female patients with vaginal abnormalities (congenital-neoplastic or fistulous). Correlation between TPUS and MRI diagnosis in each case was done, confirmed by postoperative data or close follow-up. Results TPUS achieved 100% sensitivity, specificity, and accuracy for detecting stenosis /obstruction level and cause in cases of obstructed uterine anomalies, the presence of lower vaginal pouch canalization in cases of agenesis, vaginal involvement in case of neoplastic abnormalities, and detecting fistulae/sinuses, with lower sensitivity for other gynecological disorders (66.6%) (The associated renal anomalies and the testicular tissue in disorders of sex discrimination disorder) but preserved specificity and positive predictive value (PPV) (100%). Pelvic MRI showed 100% accuracy for identifying the cause of stenosis/obstruction, other gynecological disorders, vaginal involvement, and fistulae/sinuses, but reduced sensitivity for defining stenosis level (71.4%), neoplastic extent (62.5%), local extension (75%), and lower vaginal pouch canalization (25%), with (100%) specificity and PPV in all categories. Conclusions TPUS was a noninvasive technique that complements or substitutes MRI in the assessment of different vaginal abnormalities.