Connectivity of the Superficial Muscles of the Human Perineum: A Diffusion Tensor Imaging-Based Global Tractography Study

Zifan, Ali; Reisert, Marco; Sinha, Shantanu; Ledgerwood-Lee, Melissa M.; Cory, Esther; Sah, Robert L.; Mittal, Ravinder K.

doi:10.1038/s41598-018-36099-4

Cited by 20 publications

(12 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…On its anterior side, the EAS passed the superficial transverse perineal and bulbospongious muscles superficially in the female (Wu et al, ), while a midline spur extended even further anteriorly in the male (Arakawa et al, ; Wu et al, ). We cannot exclude that some muscle fibers connect EAS and bulbospongious muscle, as reported recently in a diffusion tensor‐imaging study of perineal muscles (Zifan et al, ). However, the putative exchange area only accounted for <25% of the height of the EAS.…”

Section: New Findingsmentioning

confidence: 74%

Interactive three‐dimensional teaching models of the female and male pelvic floor

Hikspoors

Dabhoiwala

et al. 2019

Clinical Anatomy

View full text Add to dashboard Cite

Controversies regarding structure and function of the pelvic floor persist because of its poor accessibility and complex anatomical architecture. Most data are based on dissection. This "surgical" approach requires profound prior knowledge, because applying the scalpel precludes a "second look." The "sectional" approach does not entail these limitations, but requires segmentation of structures and threedimensional reconstruction. This approach has produced several "Visible Human Projects." We dealt with limited spatial resolution and difficult-to-segment structures by proceeding from clear-cut to more fuzzy boundaries and comparing segmentation between investigators. We observed that the bicipital levator ani muscle consisted of pubovisceral and puborectal portions; that the pubovisceral muscle formed, together with rectococcygeal and rectoperineal muscles, a rectal diaphragm; that the external anal sphincter consisted of its subcutaneous portion and the puborectal muscle only; that the striated urethral sphincter had three parts, of which the middle (urethral compressor) was best developed in females and the circular lower ("membranous") best in males; that the rectourethral muscle, an anterior extension of the rectal longitudinal smooth muscle, developed a fibrous node in its center (perineal body); that the perineal body was much better developed in females than males, so that the rectourethral subdivision into posterior rectoperineal and anterior deep perineal muscles was more obvious in females; that the superficial transverse perineal muscle attached to the fibrous septa of the ischioanal fat; and that the uterosacral ligaments and mesorectal fascia colocalized. To facilitate comprehension of the modified topography we provide interactive 3D-PDFs that are freely available for teaching purposes.

show abstract

Section: New Findingsmentioning

confidence: 74%

Interactive three‐dimensional teaching models of the female and male pelvic floor

Hikspoors

Dabhoiwala

et al. 2019

Clinical Anatomy

View full text Add to dashboard Cite

show abstract

“…In the current study, we confirmed the feasibility of DTI in the evaluation of pelvic floor muscles. To date, previous reports described application of DTI for evaluation of female pelvic floor muscles [ 18 - 20 , 22 ] as well as in the internal and external urinary sphincter muscles in healthy males [ 23 ]. However, to our knowledge, we are the first to investigate application of DTI acquired in 30-second frames for isometric resolution of 3×3×3 mm3.…”

Section: Discussionmentioning

confidence: 99%

“…In the muscle fibers, the diffusivity of water is larger in the direction parallel to dominant muscle fibers. Since MD expresses the average and FA the largest directionality of water molecules in random motion, the muscle architecture and function can be assessed indirectly [ 20 , 24 , 25 ]. As we observed an increase in MD during contraction of pelvic muscles, the effect might have been caused by higher uniformity of the muscle orientation compared to that during rest.…”

Section: Discussionmentioning

confidence: 99%

“…Hence, we applied a nonparametric approach along with correction for FDR due to both the log-normal character of the assessed data as well as the manual tissue segmentation applied. In the other studies, DTI of the female pelvic floor and the male urethra or the visualization of periprostatic nerval tracts were also described in 5–11 volunteers with an acquisition time of 4–18 minutes [ 18 , 20 , 22 , 23 ]. Additionally, alterations in proton diffusivity of muscle during extension and contraction were also demonstrated [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although DTI was firstly designed for neuroscientific applications [ 12 - 14 ], it was soon after acknowledged as a clinically applicable method [ 15 ] and described in skeletal muscles [ 16 , 17 ]. Feasibility of DTI was also shown for the visualization of the female pelvic floor [ 18 , 19 ] and recently also applied for assessment of superficial muscles of the human perineum [ 20 ] or course and directionality of levator ani fibers in females [ 21 ]. However, the presented approaches did not include fast assessment of the muscle function.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Evaluation of Urinary Sphincter Function by Rapid Magnetic Resonance Diffusion Tensor Imaging

et al. 2020

View full text Add to dashboard Cite

Purpose: This study aimed to assess the feasibility of a rapid diffusion tensor imaging (DTI) for evaluation of the female urinary sphincter function based on differentiation between rest and muscle contraction.Methods: Magnetic resonance imaging (MRI) of the lower pelvis was performed at 3 Tesla in 10 healthy female volunteers (21–36 years; body mass index, 20.8±3.6 kg/m2) between June and July 2019. High-resolution T1- and T2-weighted images were acquired for anatomical reference, and following DTI performed in 4 experiment phases: twice during rest (denoted rest-1, rest-2) and contraction (contraction-1, contraction-2). Manual segmentation of the urinary sphincter and the levator ani muscles were performed by 2 independent readers. Mean diffusivity (MD) and fractional anisotropy (FA) values derived from DTI volumes were compared in search for significant differences between the experiment phases. Interreader agreement was assessed by intraclass correlation coefficient (ICC).Results: Kruskal-Wallis test showed significant differences between MD values among all the experiment phases, by both independent readers (1st: X2 [3,76]=17.16, P<0.001 and 2nd: X2 [3,76]=15.88, P<0.01). Post hoc analysis revealed differences in MD values by both readers between: rest-1 vs. contraction-1 (least P<0.05), rest-1 vs. contraction-2 (P<0.01), rest-2 vs. contraction-1 (P<0.03), rest-2 vs. contraction-2 (P=0.02) with overall mean ‘rest’ to ‘contraction’ ΔMD=20.6%. No MD or FA differences were found between rest-1 vs. rest-2 and contraction-1 vs. contraction-2 among all the experiment phases, and interreader agreement was ICC=0.85 (MD) and ICC=0.79 (FA).Conclusions: Rapid DTI might prospectively act as a supporting tool for the evaluation of female pelvic floor muscle function, and incontinence assessment.

show abstract

Evaluation of the female bladder neck and urethra using MRI with fiber tractography: Prospective study on a large cohort of continent women

Roy

Ohana

Labani

et al. 2021

Neurourology and Urodynamics

View full text Add to dashboard Cite

Aims: To prospectively evaluate the performance of a last generation magnetic resonance imaging (MRI) device with tractography to identify the normal female urethral sphincters in terms of morphology and quantification on a large cohort of continent women. Methods: We have recorded the data of 75 continent women who underwent a diffusion tensor imaging (DTI) sequence with fiber tractography during a pelvic MR examination. Three groups of age were analyzed in terms of color fiber tracking quality and quantitative parameters (fractional anisotropy [FA] and mean diffusibility [MD]). Statistical analysis was done for the qualitative assessment using weighted kappa statistics of Cohen and for the quantitative parameters using a non-parametric Kruskal-Wallis test. Results: For all cases, fiber-tracking resulted in a satisfactory representation of the complexity of the orientation of the fibers. The interobserver concordance of qualitative data was substantial, calculated at 0.78 (confidence interval: 0.71-0.85). For FA, there was no statistically significant difference with the age between the three urethral segments (p > 0.05). However, we registered a significant difference inside each group between the different segments (p < 0.05), corresponding to different orientation of fibers. For MD, we have found a statistically significant difference both between levels inside each group and according the age, meaning a variation of the water mobility for each type of musculature and with age (p < 0.05). Conclusion: DTI with fiber tractography performed on a recent MR unit is a robust method for the three-dimensional visualization of the details and connections of the urethral female sphincters. Quantitative variations with age need to be considered.

show abstract

Connectivity of the Superficial Muscles of the Human Perineum: A Diffusion Tensor Imaging-Based Global Tractography Study

Cited by 20 publications

References 35 publications

Interactive three‐dimensional teaching models of the female and male pelvic floor

Interactive three‐dimensional teaching models of the female and male pelvic floor

Evaluation of Urinary Sphincter Function by Rapid Magnetic Resonance Diffusion Tensor Imaging

Evaluation of the female bladder neck and urethra using MRI with fiber tractography: Prospective study on a large cohort of continent women

Contact Info

Product

Resources

About