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Accurate preoperative diagnosis and classification are vital for surgical planning. This study aims to evaluate the diagnostic value of high-resolution three-dimensional (3D) T2-weighted MRI in the preoperative assessment and classification of HWWS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>The study prospectively enrolled 84 patients clinically diagnosed with HWWS between May 2020 and January 2025. Seventy patients underwent pelvic MRI examinations, including high-resolution 3D T2 sequences (1\u2009mm slice thickness) and conventional T2 TSE sequences, supplemented by large-field-of-view (FOV) T2 coronal imaging for urinary system evaluation and full-spine X-ray examinations for skeletal assessment. Two experienced radiologists independently evaluated the imaging features in a blinded manner, focusing on uterine morphology, obstruction sites, presence of communications, and related anomalies and complications. Consistency analysis was performed between imaging findings and surgical results in 52 surgical patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Uterine morphology included: didelphys (54\/70, 77.1%), complete septate (14\/70, 20%), and bicornuate uterus (2\/70, 2.9%). Among 52 surgical patients, 31 (59.6%) had vaginal-level obstruction with 18 (34.6%) Type I, 11 (21.2%) Type II, and 2 (3.8%) Type III, and 21 (40.4%) had cervical-level obstruction (Type IV and mixed). 3D T2 sequences identified 7 (63.6%) vaginal septum fistulas, outperforming TSE sequences, which detected none (0%) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005). Associated findings were ipsilateral renal agenesis (98.6%), ovarian endometriosis (22.9%), hematosalpinx (22.9%), and spinal abnormalities (scoliosis (25.7%), mild scoliosis (41.4%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>High-resolution 3D T2 MRI is superior to conventional T2 TSE sequences in the preoperative evaluation of HWWS, especially for identifying communications and precisely locating obstruction sites.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      Accurate preoperative structural assessment and classification of HWWS are clinically essential, yet conventional MRI has limitations in identifying fine anatomical structures and small communications.\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      High-resolution 3D T2 MRI outperforms conventional T2 TSE in identifying vaginal and cervical communications and precisely localizing obstruction sites in preoperative evaluation of HWWS.\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Critical relevance statement<\/jats:italic>\n                      <\/jats:bold>\n                      This study supports routine inclusion of 3D sequences in HWWS imaging protocols. Combined with renal and spinal assessment, it provides a comprehensive preoperative evaluation that enhances surgical planning precision and optimizes patient management strategies.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13244-026-02405-2","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:06:39Z","timestamp":1791565599000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The diagnostic value of high-resolution 3D T2-weighted MRI in preoperative evaluation and classification of Herlyn-Werner-Wunderlich syndrome: a prospective study"],"prefix":"10.1186","volume":"17","author":[{"given":"Yafei","family":"Qi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuang","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiwei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonglan","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Menglin","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4278-2165","authenticated-orcid":false,"given":"Huadan","family":"Xue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lan","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"key":"2405_CR1","doi-asserted-by":"publisher","first-page":"790","DOI":"10.1016\/j.fertnstert.2014.05.025","volume":"102","author":"J Tong","year":"2014","unstructured":"Tong J, Zhu L, Chen N, Lang JH, Wang Y, Zhang L (2014) Endometriosis in association with Herlyn-Werner-Wunderlich syndrome. 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