MR Imaging of the Pelvic Floor

Comparison of cervical length measured by POP-Q C-D and MRI: Why is POP-Q C-D not accurate?

“…This was a pilot study comparing the cervical length based on MRI compared with POP-Q C-D in cases of POP. Due to its excellent soft tissue resolution [23], it is reasonable to think that there would be no difficulties in measuring the cervical length on MRI. So we think that MCL can represent the actual length of the cervix.…”

MRI comparative study of levator ani muscle changes in nulliparous and multiparous females

“…The compartments of the pelvic floor are supported by a complex network of fascia, ligaments, and pelvic floor muscles that form 3 layers of support the endopelvic fascia (superior), the pelvic diaphragm which is also called levator ani complex (middle), and the perineal membrane or urogenital diaphragm (inferior). The fascia and ligaments provide passive support, while the pelvic diaphragm muscles provide the underlying tone and can be recruited for active support [8].…”

“…Endopelvic fascial defect: which wraps the pelvic organs supporting them "but it is normally too thin to be recognized at MR imaging except for its condensations (the cardinal, uterosacral, and urethral ligaments) Level I fascial defect: it is caused by detachment of the uterosacral ligament with consequent posterior sagging of the vagina bilaterally giving the "chevron sign". Level II fascial defect: it is caused by loss of the vaginal supporting fascia from the lateral pelvic wall leading to sagging of the posterior urinary bladder wall and loss of vaginal normal configuration that is known as "Saddle Bags sign" Level III fascial defect: it is caused by bilateral sagging of the fat in the pre-vesical space against the detached lower third of the anterior vaginal wall from the arcus tendineus fascia pelvis it is recognized as "Drooping Mustache" [8,9]. Vaginal configuration: normally it is butterfly or H shaped.…”

Practical guide to dynamic pelvic floor MRI

“…The uterosacral ligaments provide major support to the uterus and upper vagina. Complete tear of the supporting ligaments results in uterine descent into the vaginal introitus; resultant pulling and tearing of the vaginal supporting ligaments can cause complete vaginal eversion and uterine prolapse outside the vaginal introitus . Defects in the pubocervical fascia, rectovaginal fascia, parametrium, and paracolpium contribute to the uterine and vaginal prolapse.…”

“…56 Overdistension of the urinary bladder should be avoided since a distended bladder is associated with underestimation of pelvic organ prolapse severity and an overdistended cystocele may obscure findings in other compartments. 57,58…”