MR Imaging–based Assessment of the Female Pelvic Floor

Abstract

Pelvic floor weakness is a functional condition that affects the anatomic structures supporting the pelvic organs: fasciae, ligaments, and muscles. It is a prevalent disorder among people older than 50 years, especially women, and may substantially diminish their quality of life. Many complex causes of pelvic floor weakness have been described, but the greatest risk factors are aging and female sex. Pelvic floor weakness can provoke a wide range of symptoms, including pain, urinary and fecal incontinence, constipation, difficulty in voiding, a sense of pressure, and sexual dysfunction. When the condition is diagnosed solely on the basis of physical and clinical examination, the compartments involved and the site of prolapse are frequently misidentified. Such errors contribute to a high number of failed interventions. Magnetic resonance (MR) imaging, which allows visualization of all three compartments, has proved a reliable technique for accurate diagnosis, especially when involvement of multiple compartments is suspected. MR imaging allows precise evaluation of ligaments, muscles, and pelvic organs and provides accurate information for appropriate surgical treatment. Moreover, dynamic MR imaging with steady-state sequences enables the evaluation of functional disorders of the pelvic floor. The authors review the pelvic floor anatomy, describe the MR imaging protocol used in their institutions, survey common MR imaging findings in the presence of pelvic floor weakness, and highlight key details that radiologists should provide surgeons to ensure effective treatment and improved outcomes.

Prospective Comparison between two different magnetic resonance defecography techniques for evaluating pelvic floor disorders: air-balloon versus gel for rectal filling

“…The two techniques were directly compared by adopting a widely used grading system for POP based on the pubococcygeal line and rule of the Bthree^: an organ prolapse below the PCL less than 3 cm was considered mild, between 3-6 cm moderate, and over 6 cm severe [2, 3, 5-13, 24-27, [26][27][28]. A direct quantitative comparison between the two techniques was also obtained, regarding rectocele, cystocele and AJR descent.…”

Practical guide to dynamic pelvic floor MRI

“…Appropriate placement of these lines is the first and one of the most crucial steps in interpreting dynamic pelvic floor MRI. The most commonly used reference line is the pubococcygeal line (PCL), which represents the level of the pelvic floor . The PCL is drawn from the most inferior aspect of the pubic symphysis to the last coccygeal joint (Fig.…”

“…The PCL is drawn from the most inferior aspect of the pubic symphysis to the last coccygeal joint (Fig. ) . An alternative, less commonly used reference line for evaluation of the pelvic floor is called the midpubic line (MPL).…”

“…The use of the PCL offers greater simplicity and higher interobserver agreement over the MPL . Therefore, the PCL is the reference line most frequently used for measuring organ prolapse, including at our institution . However, the decision to use the MPL or PCL as the reference line should be tailored to the individual clinical practice, taking into account the preferences of the referring physicians.…”

The value of dynamic magnetic resonance imaging in interdisciplinary treatment of pelvic floor dysfunction

“…In distinction to conventional defecography, MRI allows, without utilization of ionizing radiation, a comprehensive visualization of the interaction of the pelvic floor and viscera with greater soft tissue contrast, a shorter patient preparation time, and greater patient comfort [8]. Thus, dynamic pelvic floor MRI has become a widely accepted imaging modality for the assessment of pelvic floor dysfunction [9][10][11]. In particular, MRI is especially useful in the detection of enteroceles-a potential cause of evacuatory dysfunction resulting from rectal pouch obstruction-which are otherwise difficult to detect [12][13][14][15][16].…”