Radiologic Evaluation of Uterine Vasculature of Uterus Transplant Living Donor Candidates: DUETS Classification

Abstract: Uterus transplantation is a treatment solution for women suffering from absolute uterine
factor infertility. As much as 19.5% of uterus-transplanted patients underwent urgent graft hysterectomy
due to thrombosis/hypoperfusion. The necessity to identify candidates with high-quality
uterine vasculature is paramount. We retrospectively evaluated and compared the imaging results
with actual vascular findings from the back table. In this article, we present a novel radiologic
grading scale (DUETS classification) for evaluating both uterine arteries and veins concerning their
suitability for uterus procurement and transplantation. This classification defines several criteria for
arteries (caliber, tapering, atherosclerosis, tortuosity, segment, take-off, and course) and veins (caliber,
tapering, plethora, fenestrations, duplication/multiplicity, dominant route of venous drainage, radiologist’s
confidence with imaging and assessment). In conclusion, magnetic resonance angiography
can provide reliable information on uterine venous characteristics if performed consistently according
to a well-established protocol and assessed by a dedicated radiologist. The caliber of uterine
arteries seems to be inversely related to the time passed since the last delivery. We recommend
that the radiologist comments on the reliability and confidence of the imaging study. It cannot be
over-emphasized that the most crucial aspect of surgical imaging is the necessity of high-quality
communication between a surgeon and a radiologist.