Measurement of the 3D geometry of the fascial arches in women with a unilateral levator defect and “architectural distortion”

Larson, Kindra; Luo, Jiajia; Yousuf, Aisha; Ashton‐Miller, James A.; DeLancey, John O.L.

doi:10.1007/s00192-011-1528-7

Cited by 25 publications

(23 citation statements)

References 20 publications

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“…First, bony landmarks such as most inferior pubic symphysis, ischial spines and sacrococcygeal junction (SCJ) were identified on T1w and T2w images [16]. These landmarks were used to align different MR image sequences in the same 3D space.…”

Section: Methodsmentioning

confidence: 99%

MRI visible Fe3O4 polypropylene mesh: 3D reconstruction of spatial relation to bony pelvis and neurovascular structures

et al. 2017

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Introduction and hypothesis To demonstrate mesh magnetic resonance (MR) visibility in living women, the feasibility of reconstructing the full mesh course in 3D and document its spatial relationship to pelvic anatomical structures. Methods This is a proof of concept study of three patients from a prospective multi-center trial evaluating women with anterior vaginal mesh repair using a MR-visible Fe3O4-polypropylene implant for pelvic floor reconstruction. High resolution sagittal T2-weighted sequences, transverse T1-weighted (T1w) FLASH 2D and transverse T1w FLASH 3D sequences were performed to evaluate Fe3O4-polypropylene mesh MR-visibility and overall postsurgical pelvic anatomy three months after reconstructive surgery. Full mesh course as well as important pelvic structures were reconstructed using the 3D Slicer® software program based on T1 and T2 MR-images. Results Three women with POP-Q grade III cystoceles were successfully treated with a partially absorbable MR-visible anterior vaginal mesh with 6 fixation arms showing no recurrent cystocele in the 3 months follow-up examination. The course of mesh in the pelvis was visible on MR-images in all three women. The mesh body and arms could be reconstructed allowing visualization of the full course of the mesh in relationship to important pelvic structures such as the obturator or pudendal vessel-nerve bundles in 3D. Conclusions The use of MR-visible Fe3O4-polypropylene meshes in combination with post-surgical 3D reconstruction of the mesh and adjacent structures is feasible suggesting it might be a useful tool to more precisely evaluate mesh complications and might be a valuable interactive feedback tool for surgeons and mesh design engineers.

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Section: Methodsmentioning

confidence: 99%

MRI visible Fe3O4 polypropylene mesh: 3D reconstruction of spatial relation to bony pelvis and neurovascular structures

et al. 2017

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“…As described in our previous work [6,12], each subject underwent supine multi-planar, two-dimensional, fast spin, proton density MR imaging both at rest and during maximal Valsalva using a 3 T superconducting magnet (Philips Medical Systems Inc, Bothell, WA) with version 2.5.1.0 software. At rest, each 30 images were serially obtained at the axial, sagittal, and coronal, with 20×20 cm fields of view, 4 mm slice thickness, and a 1 mm gap between slices.…”

Section: Methodsmentioning

confidence: 99%

“…This registration information was then applied to the soft tissue images making it possible to align the subsequently constructed 3-D posterior vaginal wall with the previously created resting models using the pubic symphysis and sacrum. A reference line was constructed on each side of the pelvis representing the normal location of the arcus tendineus fascia pelvis (ATFP) from its pubic attachments to the ipsilateral ischial spine (“P-IS” line) for visual reference and consideration for future measurement purposes [6,12]. …”

Section: Methodsmentioning

confidence: 99%

Posterior vaginal prolapse shape and position changes at maximal Valsalva seen in 3-D MRI-based models

et al. 2012

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Introduction and Hypothesis Two-dimensional magnetic resonance imaging (MRI) of posterior vaginal prolapse has been studied. However, the three-dimensional (3-D) mechanisms causing such prolapse remain poorly understood. This discovery project was undertaken to identify the different 3-D characteristics of models of rectocele-type posterior vaginal prolapse (PVPR) in women. Methods Ten women with (cases) and 10 without (controls) PVPR were selected from an ongoing case-control study. Supine, multi-planar MR imaging was performed at rest and maximal Valsalva. 3-D reconstructions of the posterior vaginal wall and pelvic bones were created using 3D Slicer v. 3.4.1. In each slice the posterior vaginal wall and perineal skin were outlined to the anterior margin of the external anal sphincter to include the area of the perineal body. Women with predominant enteroceles or anterior vaginal prolapse were excluded. Results The case and control groups had similar demographics. In women with PVPR two characteristics were consistently visible (10 of 10): 1) the posterior vaginal wall displayed a folding phenomenon similar to a person beginning to kneel (“Kneeling” shape); and 2) a downward displacement in the upper 2/3 of the vagina. Also seen in some, but not all of the scans were: 3) forward protrusion of the distal vagina (6 of 10); 4) perineal descent (5 of 10); and 5) distal widening in lower third of the vagina (3 of 10). Conclusions Increased folding (“Kneeling”) of the vagina and an overall downward displacement are consistently present in rectocele. Forward protrusion, perineal descent and distal widening are sometimes seen as well.

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“…Larson examined the anatomical basis for “architectural distortion” in 2011 [54]. She included a group of 14 women who had unilateral architectural distortion that could be compared with normal anatomy on the other side using MRI and 3D models.…”

Section: Diagnosing a Paravaginal Defectmentioning

confidence: 99%

Paravaginal defect: anatomy, clinical findings, and imaging

et al. 2016

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Introduction and Hypothesis The paravaginal defect has been a topic of active discussion concerning 1) what it is; 2) how to diagnose it; 3) its role in anterior vaginal wall prolapse; and 4) if and how to repair it. The aim of this article is to review the existing literature on the paravaginal defect and to discuss its role in the anterior vaginal wall support system, with an emphasis on anatomy and imaging. Methods Articles related to paravaginal defects were identified through a PUBMED search ending July 1, 2015. Results The support of the anterior vaginal wall is a complex system involving the levator ani muscle, the arcus tendineus fascia pelvis (ATFP), the pubocervical fascia, and the uterosacral/cardinal ligaments. Studies conclude that physical examination is inconsistent in detecting paravaginal defects. Ultrasound (US) and magnetic resonance imaging (MRI) have been used to describe patterns in the appearance of the vagina and bladder when a paravaginal defect is suspected. Different terms have been used (e.g. “sagging of bladder base,” “loss of tenting”), which all represent changes in the support of the pelvic floor but which could be due to both paravaginal defects and levator ani defects. Conclusion Paravaginal support plays a role in the support of the anterior vaginal wall, but we still do not know the degree to which it contributes to the development of prolapse. Both MRI and US are useful in the diagnosis of paravaginal defects, but further studies are needed to evaluate their use.

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Measurement of the 3D geometry of the fascial arches in women with a unilateral levator defect and “architectural distortion”

Cited by 25 publications

References 20 publications

MRI visible Fe3O4 polypropylene mesh: 3D reconstruction of spatial relation to bony pelvis and neurovascular structures

MRI visible Fe3O4 polypropylene mesh: 3D reconstruction of spatial relation to bony pelvis and neurovascular structures

Posterior vaginal prolapse shape and position changes at maximal Valsalva seen in 3-D MRI-based models

Paravaginal defect: anatomy, clinical findings, and imaging

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