Dynamic Magnetic Resonance Imaging of the Pelvic Floor

Alapati, Sindhura; Jambhekar, Kedar

doi:10.1053/j.sult.2016.11.002

Cited by 18 publications

(13 citation statements)

References 15 publications

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“…Magnetic resonance imaging (MRI) with an excellent soft‐tissue contrast has been increasingly proposed as an auxiliary diagnostic tool in the assessment of LAM injury. It can be used efficiently to evaluate the morphology and function of the pelvic floor 7,8 . Both static and dynamic MRI scans provide an excellent qualitative evaluation of LAM.…”

Section: Introductionmentioning

confidence: 99%

“…It can be used efficiently to evaluate the morphology and function of the pelvic floor. 7,8 Both static and dynamic MRI scans provide an excellent qualitative evaluation of LAM.Recent preclinical studies have emphasized the need for an improved three-dimensional (3D) understanding of LAM anatomy and advanced non-invasive quantitative evaluation of LAM damage. 9 Diffusion tensor imaging (DTI) with fiber tracking is a…”

mentioning

confidence: 99%

“…It can be used efficiently to evaluate the morphology and function of the pelvic floor. 7,8 Both static and dynamic MRI scans provide an excellent qualitative evaluation of LAM.…”

mentioning

confidence: 99%

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In vivo evaluation of the levator ani muscle in primiparous women using diffusion tensor imaging and fiber tractography

Cui

Zhao

Cui

et al. 2021

Intl J Gynecology & Obste

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Objective To characterize the levator ani muscle (LAM) injury after first vaginal delivery and investigate the clinical application of diffusion tensor imaging (DTI) and fiber tractography in evaluating the LAM. Methods Fifty‐eight primiparous women at 6 weeks after vaginal delivery and 27 nulliparous women as controls underwent T2‐weighted sequence and DTI sequence of the pelvic floor. A LAM scoring system was used to characterize the morphological changes. Fiber tractography of each major subdivision of LAM was performed, followed by assessment of the quality of fiber tracking. Fractional anisotropy (FA), apparent diffusion coefficient (ADC), fiber volume, and length were calculated. Results Puborectalis and iliococcygeus injuries were observed in 30/58 (51.7%) and 10/58 (17.2%) primiparae, respectively. No LAM defects were identified in the control group. For the puborectalis, the FA values were lower (P = 0.010) and ADC values were higher (P = 0.024) in the primiparous group than in the control group. For the iliococcygeus, the fiber volume values were lower in the primiparous group than in the control group (P = 0.004). Conclusion Vaginal delivery can result in LAM injury at the puborectalis. DTI parameters can assist in the quantitative diagnosis of the LAM injury.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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In vivo evaluation of the levator ani muscle in primiparous women using diffusion tensor imaging and fiber tractography

Cui

Zhao

Cui

et al. 2021

Intl J Gynecology & Obste

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“…It influences the woman’s quality of life causing urinary and fecal incontinence, difficult defecation and pelvic pain and often requires surgical treatment [2]. Female sex and increasing age are considered the greatest risk factors [3]. Dynamic Magnetic Resonance (MR) of the pelvic floor is the only imaging modality that allows the simultaneous evaluation of all pelvic organs during the defecation.…”

Section: Introductionmentioning

confidence: 99%

“…Dynamic Magnetic Resonance (MR) of the pelvic floor is the only imaging modality that allows the simultaneous evaluation of all pelvic organs during the defecation. Therefore, it has emerged as technique to evaluate the PFD also because it provides an objective grading of this disorder [3,4]. The grading obtained during dynamic study of the dynamic MR exam is based on HMO classification system [5], which depends on three reference lines: H line, Pubococcygeal line (PCL) and M Line.…”

Section: Introductionmentioning

confidence: 99%

Dynamic MR of the pelvic floor: Influence of alternative methods to draw the pubococcygeal line (PCL) on the grading of pelvic floor descent

Picchia

Rengo

Bellini

et al. 2019

European Journal of Radiology Open

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Objective: To evaluate the impact of the pubococcygeal line (PCL) position on hiatal descent grading, comparing the method recommended by the official guidelines with the other two most common methods reported in literature. Methods: Female patients prospectively included performed dynamic-MR (1,5 T) in supine position. Rectum and vagina were filled with ultrasound gel. MR protocol included TSE T2 weighted sequences on axial/sagittal/coronal planes and steady-state sequences (FIESTA) on midsagittal plane during three phases (rest, strain and defecation). On each phase, the posterior point of PCL was traced in the region recommended by the official guidelines (last coccygeal joint or PCLcc) and in the other two regions: coccyx’s tip (PCLtip) and sacrococcygeal joint (PCLsc). The resulting grades of pelvic floor descent (according to HMO-System) were compared. Inter-reader and intra-reader agreement were evaluated. Results: The final population consisted of 60 patients (56yy±10). No significant differences in grading were observed using PCLtip and PCLcc in all phases (p = 0.3016/0.0719/0.0719 during rest/strain/defecation). Using PCLsc, the grading was significantly overestimated compared to PCLcc in all phases (p = 0.0041/0.0001/0.0001 during rest/strain/defecation). Inter-reader and intra-reader agreement were significantly higher using PCLtip (p < 0.05). Conclusions: PCLtip is a reliable and highly reproducible option to the official PCLcc to correctly grade the pelvic floor descent and could be used when the PCLcc is not clearly visible. The use of PCLsc overestimates the grading compared to the official PCLcc and should not be used to avoid wrong patients’ management.

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