Dynamic magnetic resonance imaging evaluation before and after operation for pelvic organ prolapse

Abstract

Purpose This study aimed to explore the value of dynamic magnetic resonance imaging (MRI) before and after operation for pelvic organ prolapse (POP). Methods Twenty-nine patients with POP (POP group) before and one month after surgery and 12 healthy women (control group) underwent static and dynamic MRI at rest and during straining (Valsalva maneuver). The preoperative MRI images of the POP and control groups were analyzed, and various measurements were recorded. Differences in measurements were compared between the POP and control groups; similarly, changes in measurements before and after operation were compared. Results In the POP group, MRI detected 29 anterior vaginal prolapses, 27 uterine prolapses, 1 rectoceles, and 14 pouch of Douglas hernias. In addition, 27 levator ani muscle defect and 15 pubocervical fascial defect cases were observed. The bladder-pubococcygeal line (B-PCL), uterus-pubococcygeal line (U-PCL), Douglas pouch-pubococcygeal line, the length of the hiatus, the descent of the levator plate, levator hiatus size, levator plate angle, iliococcygeus angle, and urethral inclination angle (UA) were larger in the POP group than in the control group. The pelvic organs' positions returned to normal postoperatively in 9 of 21 cases. The B-PCL, U-PCL, and UA were smaller post-surgery than pre-surgery. Conclusions Static and dynamic MRI can comprehensively evaluate morphological and functional changes of the pelvic floor postoperatively.

Radiological imaging following pelvic prolapse surgery

“…Statische MR-Bilder veranschaulichen die genaue Anatomie des Beckenbodens und potenzielle Defekte der Haltestrukturen, während dynamische MRT-Bilder zusätzlich die Beweglichkeit der Beckenorgane und eine Beckenbodenschwäche bzw. einen Genitaldeszensus unter Belastung sowie hiermit verbundene Kompartmentdefekte visualisieren [ 14 , 15 ]. Ausführliche Details hierzu finden sich in einem weiteren Artikel zum Leitthema dieser Ausgabe.…”

Four-dimensional reconstruction and characterization of bladder deformations

“…Current clinical practice involves 2D dynamic MRI acquiring a single sagittal plane during straining exercises involving excretion to qualitatively assess the displacement and deformations of the main pelvic organs (bladder, uterus-vagina, rectum). During visual inspection, radiologists assess the displacement of the pelvic organs relative to bone-anchored lines, such as the pubococcygeal line [7]. Beyond manual measurements, automated measures of strain-induced deformation features were proposed to build a quantitative characterization of the pelvic organ dynamics to distinguish pathological cases from healthy ones [8] and to graduate the severity of pelvic organ prolapses [9].…”