Dynamic MR Imaging of the Pelvic Floor Performed with Patient Sitting in an Open-Magnet Unit versus with Patient Supine in a Closed-Magnet Unit

Bertschinger, K.; Hetzer, F.; Roos, Justus E.; Treiber, Karl; Marinček, Borut; Hilfiker, Paul R.

doi:10.1148/radiol.2232010665

Cited by 206 publications

(118 citation statements)

References 18 publications

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“…We minimized this limitation by careful coaching the woman to achieve the maximal prolapse and reviewed all the dynamic video clips to make sure that Valsalva was performed correctly. In the past, researchers have compared supine dynamic MRI with those performed in a sitting position in an open configuration scanner and found supine scans during straining to be comparable in documenting pelvic floor movement [26,27]. An additional limitation is represented by the example in Fig.…”

Section: Discussionmentioning

confidence: 99%

Anterior vaginal wall length and degree of anterior compartment prolapse seen on dynamic MRI

et al. 2007

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The objective of the study was to determine the relationship between midsagittal vaginal wall geometric parameters and the degree of anterior vaginal prolapse. We have previously presented data indicating that about half of anterior wall descent can be explained by the degree of apical descent present (Summers et al., Am J Obstet Gynecol, 194:1438−1443, 2006. This led us to examine whether other midsagittal vaginal geometric parameters are associated with anterior wall descent. Magnetic resonance (MR) scans of 145 women from the prior study were suitable for analysis after eight were excluded because of inadequate visibility of the anterior vaginal wall. Subjects had been selected from a study of pelvic organ prolapse that included women with and without prolapse. All patients underwent supine dynamic MR scans in the midsagittal plane. Anterior vaginal wall length, location of distal vaginal wall point, and the area under the midsagittal profile of the anterior vaginal wall were measured during maximal Valsalva. A linear regression model was used to examine how much of the variance in cystocele size could be explained by these vaginal parameters. When both apical descent and vaginal length were considered in the linear regression model, 77% (R 2 =0.77, p<0.001) of the variation in anterior wall descent was explained. Distal vaginal point and a measure anterior wall shape, the area under the profile of the anterior vaginal wall, added little to the model. Increasing vaginal length was positively correlated with greater degrees of anterior vaginal prolapse during maximal Valsalva (R 2 =0.30, p<0.01) determining 30% of the variation in anterior wall decent. Greater degrees of anterior vaginal prolapse are associated with a longer vaginal wall. Linear regression modeling suggests that 77% of anterior wall descent can be explained by apical descent and midsagittal anterior vaginal wall length.

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Section: Discussionmentioning

confidence: 99%

Anterior vaginal wall length and degree of anterior compartment prolapse seen on dynamic MRI

et al. 2007

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“…According to previous studies, patient positioning, force of valsalva, and bladder distention have been shown to affect the severity of POP [8][9][10][11][12]. Our POP-Q exams were performed in the supine position with the patient straining.…”

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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“…7,11 A further limitation of the supine position is represented by the difficulty of carrying out the voiding phase, which is the most important phase for correct clinicalediagnostic assessment. In the present population, only 28 of the 49 patients enrolled managed to complete the MRD in the supine position, whereas all patients performed the voiding phase in the erect position.…”

Section: Discussionmentioning

confidence: 99%

Static and dynamic evaluation of pelvic floor disorders with an open low-field tilting magnet

et al. 2013

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AIM: To assess the feasibility of magnetic resonance defaecography (MRD) in pelvic floor disorders using an open tilting magnet with a 0.25 T static field and to compare the results obtained from the same patient both in supine and orthostatic positions.MATERIALS AND METHODS: From May 2010 to November 2011, 49 symptomatic female subjects (mean age 43.5 years) were enrolled. All the patients underwent MRD in the supine and orthostatic positions using three-dimensional (3D) hybrid contrast-enhanced (HYCE) sequences and dynamic gradient echo (GE) T1-weighted sequences. All the patients underwent conventional defaecography (CD) to correlate both results. Two radiologists evaluated the examinations; inter and intra-observer concordance was measured. The results obtained in the two positions were compared between them and with CD.RESULTS: The comparison between CD and MRD found statistically significant differences in the evaluation of anterior and posterior rectocoele during defaecation in both positions and of rectal prolapse under the pubo-coccygeal line (PCL) during evacuation, only in the supine position (versus MRD orthostatic: rectal prolapse p < 0.0001; anterior rectocoele p < 0.001; posterior rectocoele p ¼ 0.008; versus CD: rectal prolapse p < 0.0001; anterior rectocoele p < 0.001; posterior rectocoele p ¼ 0.01). The value of intra-observer intra-class correlation coefficient (ICC) ranged from good to excellent; the interobserver ICC from moderate to excellent.CONCLUSION: MRD is feasible with an open low-field tilting magnet, and it is more accurate in the orthostatic position than in the supine position to evaluate pelvic floor disorders.

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Dynamic MR Imaging of the Pelvic Floor Performed with Patient Sitting in an Open-Magnet Unit versus with Patient Supine in a Closed-Magnet Unit

Abstract: Dynamic supine MR imaging performed with a closed-configuration unit before and after rectal contrast agent administration appears to be an alternative to sitting MR defecography performed with an open-configuration unit for diagnosis of clinically relevant pelvic floor abnormalities.

Cited by 206 publications

References 18 publications

Anterior vaginal wall length and degree of anterior compartment prolapse seen on dynamic MRI

Anterior vaginal wall length and degree of anterior compartment prolapse seen on dynamic MRI

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

Static and dynamic evaluation of pelvic floor disorders with an open low-field tilting magnet

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