Assessment of pelvic organ descent by use of functional cine‐MRI: Which reference line should be used?

Lienemann, Andreas; Sprenger, D.; Janssen, Udo; Grosch, Eva; Pellengahr, Christoph von Schulze; Anthuber, C.

doi:10.1002/nau.10170

Cited by 89 publications

(86 citation statements)

References 16 publications

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“…Correlation of POP-Q stages with dynamic MR imaging has been studied before [6][7][8][9]. Until now, however, only one paper has compared the POP-Q centimeters and not the derivated POP-Q stages with measurements on dynamic MR imaging.…”

Section: Discussionmentioning

confidence: 99%

“…1. The pubococcygeal line was defined as a straight line between the inferior rim of the pubic bone and the last visible coccygeal joint [8,11], the H-line as a straight line between the inferior rim of the pubic bone and the posterior wall of the anal canal on the level of the impression of the puborectal sling [12], and the mid-pubic line as a line drawn through the longitudinal axis of the pubic bone, passing through its midequatorial point [9].…”

Section: Dynamic Mr Imaging Protocolmentioning

confidence: 99%

“…Four previous studies have assessed the agreement of POP-Q measurements with the use of at least one reference line on dynamic MR imaging, but resulted in conflicting findings [6][7][8][9]. With respect to ultrasonography, only one study has compared perineal ultrasonography with POP-Q, and has found good correlation for the anterior and middle compartment and moderate correlation for the posterior compartment [10].…”

Section: Introductionmentioning

confidence: 99%

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POP-Q, dynamic MR imaging, and perineal ultrasonography: do they agree in the quantification of female pelvic organ prolapse?

et al. 2009

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Introduction and hypothesis This study evaluates the agreement in prolapse staging between clinical examination, dynamic magnetic resonance (MR), imaging and perineal ultrasonography. Methods Anatomical landmarks in the anterior, central, and posterior compartment were assessed in relation to three reference lines on dynamic MR imaging and one reference line on dynamic ultrasonography. These measurements were compared to the according POP-Q measurements. Agreement between the three methods was analyzed with Spearman's rank correlation coefficient (r s ) and Bland and Altman plots. Results Correlations were good to moderate in the anterior compartment (r s range=0.49; 0.70) and moderate to poor (r s range = −0.03; 0.49) in the central and posterior compartment. This finding was independent of the staging method and reference lines used. Conclusion Pelvic organ prolapse staging with the use of POP-Q, dynamic MR imaging, and perineal ultrasonography only correlates in the anterior compartment.

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Section: Discussionmentioning

confidence: 99%

Section: Dynamic Mr Imaging Protocolmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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POP-Q, dynamic MR imaging, and perineal ultrasonography: do they agree in the quantification of female pelvic organ prolapse?

et al. 2009

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“…MRI performed in the supine/sitting position gives variable results, 29 with increased detection of anterior and posterior abnormalities. 30,31 There is also a variation in the use of contrasts such as vaginal/bladder/nil contrast, [32][33][34][35] ultrasound gel as the rectal contrast, 36 mashed potatoes with gadolinium 37 or air balloon. 38 There have been also variations in the use of a reference line to measure pelvic floor descent such as using the pubococcygeal line, mid-pubic line, perineal line or H-line (levator hiatus width line).…”

Section: Techniquementioning

confidence: 99%

Interobserver agreement of multicompartment ultrasound in the assessment of pelvic floor anatomy

Lone¹,

Sultan²,

Stankiewicz³

et al. 2016

BJR

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Objective: To assess the interobserver agreement of pelvic floor anatomical measurements using multicompartment pelvic floor ultrasound. Methods: Females were recruited from the urogynaecology/gynaecology clinics between July and October 2009 and underwent multicompartment pelvic floor ultrasonography (PFUS) using twodimensional (2D) transperineal ultrasound (TPUS), high-frequency 2D/three-dimensional (3D) endovaginal ultrasound (EVUS) using a biplane probe with linear and transverse arrays and a 360°rotational 3D-EVUS. PFUS measurements were independently analysed by two clinicians. Results: 158 females had PFUS assessment. Good-toexcellent interobserver agreement was observed for bladder-symphysis distance at rest and valsalva, urethral thickness, urethral length, urethral volume, levator hiatus area and width, anteroposterior diameter and anorectal angle. Lins Correlation was used to calculate the interobserver agreement and Bland-Altman plots were created to demonstrate the agreement between the researchers. There was also a good-to-excellent agreement between the two clinicians for the assessment of pelvic organ prolapse (POP) in the anterior, middle and posterior compartment. Conclusion: Multicompartment PFUS is a reliable tool in the anatomical assessment of pelvic floor measurements and POP. Advances in knowledge: We found a good-to-excellent agreement between the two assessors in the assessment of pelvic floor measurements for all three pelvic floor compartments and suggest that multicompartment PFUS could be considered as a systematic integrated approach to assess the pelvic floor.

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“…1. According to literature, the pubococcygeal line was defined as a straight line between the inferior rim of the pubic bone and the last visible coccygeal joint [5,6], the H-line as a straight line between the inferior rim of the pubic bone and the posterior wall of the anal canal on the level of the impression of the puborectal sling [7], and the mid-pubic line as a line drawn through the longitudinal axis of the pubic bone, passing through its midequatorial point [8].…”

Section: Reference Linesmentioning

confidence: 99%

Dynamic magnetic resonance imaging: reliability of anatomical landmarks and reference lines used to assess pelvic organ prolapse

et al. 2008

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The aim of this study was to determine the intraand interobserver reliability of dynamic magnetic resonance (MR) staging in pelvic organ prolapse patients. In 30 patients with pelvic organ prolapse, dynamic MR images were assessed independently by two observers. Various anatomical landmarks to asses pelvic organ prolapse were used in relation to the pubococcygeal line, H-line, and midpubic line. Clinical measurement points were assessed in relation to the mid-pubic line. The intraclass correlation coefficients (ICC) were calculated to describe the intraand interobserver reliability. Overall, the intra-and interobserver reliability of MR imaging measurements was excellent to good. The pubococcygeal line showed superior reliability (ICC range 0.70-0.99). The reliability of clinical measurement points, however, were only moderate (ICC range 0.20-0.96). The intra-and interobserver reliability of quantitative prolapse staging on dynamic MR imaging were good to excellent. The pubococcygeal line appears the most reliable to use.

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Assessment of pelvic organ descent by use of functional cine‐MRI: Which reference line should be used?

Abstract: Organ descent on functional cine-MRI cannot be described using only one reference line. In order to optimize clinical exploitation of functional MRI of the pelvic floor a consensus regarding imaging protocols and evaluation criteria should be aimed for.

Cited by 89 publications

References 16 publications

POP-Q, dynamic MR imaging, and perineal ultrasonography: do they agree in the quantification of female pelvic organ prolapse?

POP-Q, dynamic MR imaging, and perineal ultrasonography: do they agree in the quantification of female pelvic organ prolapse?

Interobserver agreement of multicompartment ultrasound in the assessment of pelvic floor anatomy

Dynamic magnetic resonance imaging: reliability of anatomical landmarks and reference lines used to assess pelvic organ prolapse

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