Interobserver agreement of multicompartment ultrasound in the assessment of pelvic floor anatomy

Abstract

Objective: To assess the interobserver agreement of pelvic floor anatomical measurements using multicompartment pelvic floor ultrasound. Methods: Females were recruited from the urogynaecology/gynaecology clinics between July and October 2009 and underwent multicompartment pelvic floor ultrasonography (PFUS) using twodimensional (2D) transperineal ultrasound (TPUS), high-frequency 2D/three-dimensional (3D) endovaginal ultrasound (EVUS) using a biplane probe with linear and transverse arrays and a 360°rotational 3D-EVUS. PFUS measurements were independently analysed by two clinicians. Results: 158 females had PFUS assessment. Good-toexcellent interobserver agreement was observed for bladder-symphysis distance at rest and valsalva, urethral thickness, urethral length, urethral volume, levator hiatus area and width, anteroposterior diameter and anorectal angle. Lins Correlation was used to calculate the interobserver agreement and Bland-Altman plots were created to demonstrate the agreement between the researchers. There was also a good-to-excellent agreement between the two clinicians for the assessment of pelvic organ prolapse (POP) in the anterior, middle and posterior compartment. Conclusion: Multicompartment PFUS is a reliable tool in the anatomical assessment of pelvic floor measurements and POP. Advances in knowledge: We found a good-to-excellent agreement between the two assessors in the assessment of pelvic floor measurements for all three pelvic floor compartments and suggest that multicompartment PFUS could be considered as a systematic integrated approach to assess the pelvic floor.

Does 4D transperineal ultrasound have additional value over 2D transperineal ultrasound for diagnosing posterior pelvic floor disorders in women with obstructed defecation syndrome?

“…showed excellent agreement for diagnosis of anismus on 2D‐TPUS as compared with anal and vaginal ultrasound, but diagnostic test characteristics were not calculated due to lack of a reference standard for anismus. Interobserver agreements of rectocele depth measurement on 2D‐TPUS and diagnosis of rectocele, enterocele and intussusception on 4D‐TPUS were similar to those in other studies. Dietz et al .…”

Agreement between simple catheter method and 3D transperineal ultrasound for assessing urethral length measurement before stress urinary incontinence treatment

“…The mean urethral length assessed by a foley catheter was found to resemble that assessed using 3D transperineal ultrasound (3.02 ± 0.41 cm and 3.03 ± 0.34 cm, respectively), suggesting agreement between the two methods. This data is also in line with previous studies reporting a urethral length range of 2‐4 cm measured with introital ultrasound in women with SUI . Also supporting the agreement between the two methods, the ICC obtained suggests excellent accordance (ICC = 0.90) with the standard proposed by Portney et al Moreover, the Bland‐Altman analysis revealed a mean difference close to 0 (−0.01 ± 0.23 cm), showing little to no bias between the two methods.…”

“…This data is also in line with previous studies reporting a urethral length range of 2-4 cm measured with introital ultrasound in women with SUI. 16,17,23 Also supporting the agreement between the two methods, the ICC obtained suggests excellent accordance (ICC = 0.90) with the standard proposed by Portney et al 20 Moreover, the Bland-Altman analysis revealed a mean difference close to 0 (−0.01 ± 0.23 cm), showing little to no bias between the two methods. Limits of agreement (−0.45 cm and 0.46 cm) provide a clinically acceptable range in which a minimum of 95% of the values should be expected, given the concordance between methods.…”

“…A 3D volume was then recorded at rest with the acquisition angle set to maximal. The urethral length was calculated from the postero‐inferior margin of the pubic symphysis to the bladder neck, using a methodology previously described . The mean urethral length measured in both the mid‐sagittal and the coronal planes was considered for analysis (Figure ).…”

“…The urethral length was calculated from the postero-inferior margin of the pubic symphysis to the bladder neck, using a methodology previously described. 17 The mean urethral length measured in both the mid-sagittal and the coronal planes was considered for analysis ( Figure 1). Ultrasound analysis was conducted offline by an observer blinded to the urethral length obtained with the foley catheter using the 4D View v.9.1 (GE Healthcare) software.…”