Clinical Examination and Dynamic Magnetic Resonance Imaging in Vaginal Vault Prolapse

Cortes, Eduard; Reid, Wendy; Singh, Kavita; Berger, Leslie

doi:10.1097/01.aog.0000102704.29607.fc

Cited by 43 publications

(27 citation statements)

References 30 publications

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“…Thus, a total of 509 studies were checked for eligibility, of which 432 studies could be excluded on the basis of title and abstract. The remaining 77 studies were read by paper, but only ten studies [24][25][26][27][28][29][30][31][32][33], published between 1993 and 2007, fulfilled the inclusion criteria. Sixty-one studies were excluded because they did not conform to our inclusion criteria: no report on a reference line used to stage the prolapse on dynamic MR imaging (n studies=1), no standardized method of gynecological prolapse staging (pre-or intraoperative; n studies=23), and no comparison of the dynamic MR imaging and gynecological prolapse staging (n studies = 7).…”

Section: Resultsmentioning

confidence: 99%

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A systematic review of clinical studies on dynamic magnetic resonance imaging of pelvic organ prolapse: the use of reference lines and anatomical landmarks

et al. 2009

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Introduction and hypothesis The aim of our study was to provide a systematic literature review of clinical studies on pelvic organ prolapse staging with use of dynamic magnetic resonance (MR) imaging. Methods The databases EMBASE and PubMed were searched. Clinical studies were included in case they compared pelvic organ prolapse stages as assessed on dynamic MR imaging (using a reference line) with a standardized method of clinical prolapse staging. Results Ten studies were included, which made use of seven different reference lines in relation to a wide variety of anatomical landmarks. Conclusions Only few studies have compared pelvic organ prolapse stages as assessed by dynamic MR imaging and clinical examination in a standardized manner. The available evidence suggests that prolapse assessment on dynamic MR imaging may be useful in the posterior compartment, but clinical assessment and dynamic MR imaging seem interchangeable in the anterior and central compartment.

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Section: Resultsmentioning

confidence: 99%

“…The bladder, and/or vagina, and/or rectum was/were opacified in three studies [25,29,33], whereas the other seven did not use opacification [24,[26][27][28][30][31][32], or even emptied the bladder [24,26,31]. Agildere et al [24] used an oral contrast agent (gadopentetatedimeglumine or gadopentetatedimeglumine plus polyethylene glycol).…”

Section: Resultsmentioning

confidence: 99%

A systematic review of clinical studies on dynamic magnetic resonance imaging of pelvic organ prolapse: the use of reference lines and anatomical landmarks

et al. 2009

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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%

“…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%

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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“…We propose that MRI evidence is objective and the clinical assessment was likely "under" staging maximal prolapse in the Singh study. Other studies reported a broad range in the agreement between MRI and clinical prolapse assessment, ranging from 41-85% [14,15]. Some studies reported discrepancies between MRI and POP-Q measurements as high as 3, 4, and 5cm for points Ba, C, and Bp, respectively [16].…”

Section: Discussionmentioning

confidence: 99%

Midpubic Line to Stage Pelvic Organ Prolapse by MRI Defecography As Compared to POP-Q

Schachar¹

2014

OGIJ

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described as a landmark for MRI staging of pelvic organ prolapse. Fresh cadaver data has established the midpubic line as a reliable indicator of the clinical hymen, which is the landmark used for clinical scoring [4].Previous studies have shown MRI to demonstrate a more advanced degree of prolapse; however, none have attempted to establish POP-Q equivalent MRI scoring. The merging of clinical and radiological reference points would allow detailed compartmental comparison between clinical and MRI evaluation. AbstractObjective: To compare the degree of pelvic organ prolapse (POP) as measured by the pelvic organ prolapse quantification (POP-Q) system to the degree of prolapse as measured by magnetic resonance imaging (MRI) defecography and to merge clinical and radiologic terminology in reference to POP.Methods: A retrospective analysis of 29 patients who presented with POP and defecatory complaints and underwent MRI defecography (2008)(2009)(2010)(2011). POP-Q scores were recorded by two attending urogynecologists. A radiologist, blinded to the clinical POP-Q scores, measured the maximum prolapse of the anterior vagina, posterior vagina, and vaginal apex/cervix on each subject's MRI.Results: Prolapse as measured by MRI defecography was significantly more advanced as compared to the clinical POP-Q measurements in all three compartments studied. The differences were both statistically significant and potentially, clinically relevant. A mean difference of 2.0 centimeters ± 1.5 SD, 2.3 centimeters ± 2.7 SD, and 5.0 centimeters ± 2.0 SD was observed in the anterior, apical, and posterior vaginal compartments, respectively. Conclusion:The increased degree of prolapse as demonstrated by MRI defecography may change clinical decision making and surgical planning. Therefore, MRI defecography may be a valuable adjunct in the clinical assessment of POP. 2/5 Materials and MethodsThis retrospective study was conducted at North Shore University Hospital. Institutional review board approval was obtained. Thirty-six women presenting for assessment of POP, who required MRI defecography as part of their clinical assessment, constituted the study population. The senior authors examined all patients in the study using the standard guidelines for the POP-Q examination. The clinical exams and MRIs were performed prior to any intent of studying the relationship between MRI and the POP-Q examination. MRI TechniquePatients underwent MRI with a 1.5-T scanner (Signa Excite HDx; GE Healthcare, Milwaukee, WI) with an 8-channel phased array coil in the supine position. Patients administered a fleet enema in the morning and emptied their bladders prior to imaging. 60ml of sterile lubricating jelly (Triad Disposables, Inc, Mukwonago, WI) was instilled into the vagina. 200ml of lubricating ultrasound transmission gel (Aquasonic, Parker Laboratories, Inc, Fairfield, NJ) was instilled into the rectum.Following an initial three plane localizer sequence, sagittal images were obtained employing a steady-state acquisition (FIESTA=fast imaging employin...

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Clinical Examination and Dynamic Magnetic Resonance Imaging in Vaginal Vault Prolapse

Abstract: There is poor correlation between clinical and MRI findings when assessing vaginal apex prolapse. Magnetic resonance imaging allows the identification of other prolapsing compartments and may be a complementary diagnostic tool for the diagnosis of complex vaginal apex prolapse.

Cited by 43 publications

References 30 publications

A systematic review of clinical studies on dynamic magnetic resonance imaging of pelvic organ prolapse: the use of reference lines and anatomical landmarks

A systematic review of clinical studies on dynamic magnetic resonance imaging of pelvic organ prolapse: the use of reference lines and anatomical landmarks

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

Midpubic Line to Stage Pelvic Organ Prolapse by MRI Defecography As Compared to POP-Q

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