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García-Mejido JA, Martín-Martinez A, González-Diaz E, Núñez-Matas MJ, Fernández-Palacín A, Carballo-Rastrilla S, Fernández-Fernández C, García-Jimenez R, Sainz-Bueno JA. Is It Possible to Diagnose Surgical Uterine Prolapse With Transperineal Ultrasound? Multicenter Validation of Diagnostic Software. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2673-2681. [PMID: 37421644 DOI: 10.1002/jum.16303] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/24/2023] [Accepted: 06/23/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES To validate an ultrasound software that uses transperineal ultrasound to diagnose uterine prolapse (UP). METHODS Multicenter, observational and prospective study with 155 patients that had indications for surgical intervention for dysfunctional pelvic floor pathology. Each patient underwent an examination with Pozzi tenaculum forceps was performed in the operating room with the patient anesthetized, followed by surgical correction of stages II-IV UP. Transperineal ultrasound was used to assess the difference in the pubis-uterine fundus measurement. With a multivariate logistic regression binary model (with the measurement ultrasound at rest, the Valsalva maneuver and age) using nonautomated methods to predict UP. With the purpose of evaluating the model, a table with coordinates of the receiver operating characteristic (ROC) curve, after which sensitivity and specificity were assessed. RESULTS A total of 153 patients were included (73 with a diagnosis of surgical UP). It was obtained from the AUC (0.89) of the probabilities predicted by the model (95% confidence interval, 0.84-0.95; P < .0005). Based on the ROC curve for the model, obtaining a sensitivity of 91.8% and a specificity of 72.7%, values that were superior to those for the clinical exam for surgical UP (sensitivity: 80.8%; specificity: 71.3%). CONCLUSIONS We validated software that uses transperineal ultrasound of the pelvic floor and patient age to generate a more reliable diagnosis of surgical UP than that obtained from clinical examinations.
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Affiliation(s)
- José Antonio García-Mejido
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Seville, Seville, Spain
| | - Alicia Martín-Martinez
- Department of Obstetrics and Gynecology, University Healthcare Complex of Gran Canaria, Gran Canaria, Spain
| | - Enrique González-Diaz
- Department of Obstetrics and Gynecology, University Healthcare Complex of Leon (CAULE), Leon, Spain
| | - María José Núñez-Matas
- Department of Obstetrics and Gynecology, Virgen de la Victoria University Hospital of Malaga, Malaga, Spain
| | - Ana Fernández-Palacín
- Biostatistics Unit, Department of Preventive Medicine and Public Health, University of Seville, Seville, Spain
| | - Sonia Carballo-Rastrilla
- Department of Obstetrics and Gynecology, University Healthcare Complex of Gran Canaria, Gran Canaria, Spain
| | | | - Rocío García-Jimenez
- Department of Obstetrics and Gynecology, Juan Ramón Jimenez Hospital, Seville, Spain
| | - José Antonio Sainz-Bueno
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Seville, Seville, Spain
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Cao X, Qiu Y, Peng Z, Chen L, Zhou L, Lu A, Chen C, Liu P. Clinical application of a fixed reference line in the ultrasound quantitative diagnosis of female pelvic organ prolapse. BMC Med Imaging 2023; 23:170. [PMID: 37904129 PMCID: PMC10617056 DOI: 10.1186/s12880-023-01013-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/06/2023] [Indexed: 11/01/2023] Open
Abstract
OBJECTIVE This study explored using an improved ultrasound (US) for quantitative evaluation of the degree of pelvic organ prolapse(POP). DESIGN A transluminal probe was used to standardize ultrasound imaging of pelvic floor organ displacements. A US reference line was fixed between the lower edge of the pubic symphysis and the central axis of the pubic symphysis at a 30°counterclockwise angle. METHOD Points Aa, Ba, C and Bp on pelvic organ prolapse quantification (POP-Q) were then compared with the points on pelvic floor ultrasound (PFUS). RESULTS One hundred thirteen patients were included in the analysis of the standard US plane. Correlations were good in the anterior and middle compartments (PBN:Aa, ICC = 0.922; PBB:Ba, ICC = 0.923; and PC:C, ICC = 0.925), and Bland-Altman statistical maps corresponding to the average difference around the 30°horizontal line were close to 0. Correlations were poor in the posterior compartment (PRA:Bp, ICC = 0.444). However, eight (7.1%) cases of intestinal hernia and 21 (18.6%) cases of rectocele were diagnosed. CONCLUSIONS Introital PFUS using an intracavitary probe, which is gently placed at the introitus of the urethra and the vagina, may be accurately used to evaluate organ displacement. The application of a 30°horizontal line may improve the repeatability of the US diagnosis of POP.
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Affiliation(s)
- Xiaojuan Cao
- Department of Obstetrics and Gynecology, Nanfang Hospital , Southern Medical University, Guangzhou, Guangdong, 510515, China
- Department of Obstetrics and Gynecology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, 518101, China
| | - Yuwen Qiu
- Department of Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Zhiyong Peng
- Department of Anesthesiology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, 518101, China
| | - Lan Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital , Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Li Zhou
- Department of Obstetrics and Gynecology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, 518101, China
| | - Anwei Lu
- Department of Obstetrics and Gynecology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, 518101, China
| | - Chunlin Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital , Southern Medical University, Guangzhou, Guangdong, 510515, China.
| | - Ping Liu
- Department of Obstetrics and Gynecology, Nanfang Hospital , Southern Medical University, Guangzhou, Guangdong, 510515, China.
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Gilyadova A, Ishchenko A, Puchkova E, Mershina E, Petrovichev V, Reshetov I. Diagnostic Value of Dynamic Magnetic Resonance Imaging (dMRI) of the Pelvic Floor in Genital Prolapses. Biomedicines 2023; 11:2849. [PMID: 37893222 PMCID: PMC10604435 DOI: 10.3390/biomedicines11102849] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/03/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
Pelvic organ prolapse is a chronic disease resulting from a weakening of the musculoskeletal apparatus of the pelvic organs. For the diagnosis of this pathology, it is insufficient to conduct only a clinical examination. An effective diagnostic tool is the method of dynamic magnetic resonance imaging (MRI) of the pelvic floor, which allows a comprehensive assessment of the anatomical and functional characteristics of the walls of the pelvis and pelvic organs. The aim of the study was to analyze the literature data on the possibilities and limitations of using dynamic MRI in pelvic organ prolapse. The widespread use of the dynamic MRI method is due to the high quality of the resulting image, good reproducibility, and the maximum ability to display the characteristics of the pelvic floor. Dynamic MRI of the small pelvis allows a comprehensive assessment of the anatomical and functional features of the pelvis, excluding the effect of ionizing radiation on the body. The method is characterized by good visualization with high resolution and excellent soft tissue contrast. The method allows for assessing the state of the evacuation function of visualized structures in dynamics. Simultaneous imaging of all three parts of the pelvic floor using dynamic MRI makes it possible to assess multicompartment disorders. The anatomical characteristics of the state of the pelvic organs in the norm and in the event of prolapse are considered. The technique for performing the method and the procedure for analyzing the resulting images are described. The possibilities of diagnosing a multicomponent lesion are considered, while it is noted that dynamic MRI of the pelvic organs provides visualization and functional analysis of all three parts of the pelvis and often allows the choice and correction of tactics for the surgical treatment of pelvic organ prolapse. It is noted that dynamic MRI is characterized by a high resolution of the obtained images, and the advantage of the method is the ability to detect functional changes accompanying the pathology of the pelvic floor.
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Affiliation(s)
- Aida Gilyadova
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Ministry of Health of the Russian Federation, 119435 Moscow, Russia;
- National Medical Research Center Treatment and Rehabilitation Center of the Ministry of Health of the Russian Federation, 125367 Moscow, Russia; (A.I.); (V.P.)
| | - Anton Ishchenko
- National Medical Research Center Treatment and Rehabilitation Center of the Ministry of Health of the Russian Federation, 125367 Moscow, Russia; (A.I.); (V.P.)
| | - Elena Puchkova
- Group of Companies “Mother and Child”, Clinical Hospital “Lapino”, 117209 Moscow, Russia;
| | - Elena Mershina
- Medical Research and Education Center Moscow State University Named after M.V. Lomonsov, 119192 Moscow, Russia;
| | - Viktor Petrovichev
- National Medical Research Center Treatment and Rehabilitation Center of the Ministry of Health of the Russian Federation, 125367 Moscow, Russia; (A.I.); (V.P.)
| | - Igor Reshetov
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Ministry of Health of the Russian Federation, 119435 Moscow, Russia;
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4
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Jha P, Sarawagi R, Malik R, Kumar A, Pushpalatha K. Static and Dynamic Magnetic Resonance Imaging in Female Pelvic Floor Dysfunction: Correlation With Pelvic Organ Prolapse Quantification. Cureus 2023; 15:e44915. [PMID: 37814774 PMCID: PMC10560544 DOI: 10.7759/cureus.44915] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Pelvic organ prolapse (POP) is clinically assessed and staged commonly by the pelvic organ prolapse quantification (POP-Q) system. Dynamic magnetic resonance imaging (MRI) of the pelvic floor is an emerging modality for anatomical and functional assessment of the pelvic floor and staging of POP. The purpose of this study was to correlate the dynamic MRI findings with POP-Q examination for the staging of POP in each pelvic compartment by comparing various anatomic points. METHODS A prospective observational study of the comparative cross-sectional design was conducted among patients who underwent MRI of the pelvic floor and POP-Q at our institute. A total of 50 patients were included. Anatomical landmarks in the three compartments were analyzed in relation to standard reference lines on dynamic MRI and compared with POP-Q measurements. RESULTS Most of our patients had multicompartment disease (70%). When compared to POP-Q, MRI has a strong correlation for quantification of anterior (0.723) and middle (0.525) compartments and a weak correlation (0.232) for posterior compartment prolapse. CONCLUSION POP-Q examination is based on the various points within the vaginal canal, and all the points do not represent a true anatomic landmark. MRI, on the other hand, is based on a true anatomical plane and gives detailed information about various structures in all three compartments. Thus, MRI also helps bridge the gap between various referring specialties in treating pelvic floor disorders.
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Affiliation(s)
- Pallavi Jha
- Radiology, All India Institute of Medical Sciences, Bhopal, IND
| | - Radha Sarawagi
- Radiology, All India Institute of Medical Sciences, Bhopal, IND
| | - Rajesh Malik
- Radiology, All India Institute of Medical Sciences, Bhopal, IND
| | - Aman Kumar
- Radiology, All India Institute of Medical Sciences, Bhopal, IND
| | - K Pushpalatha
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhopal, IND
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Ghafoor S, Beintner-Skawran SM, Stöckli G, Betschart C, Reiner CS. Pelvic organ movements in asymptomatic nulliparous and symptomatic premenopausal women with pelvic organ prolapse in dynamic MRI: a feasibility study comparing midsagittal single-slice with multi-slice sequences. Abdom Radiol (NY) 2023; 48:2658-2671. [PMID: 37208547 PMCID: PMC10333376 DOI: 10.1007/s00261-023-03944-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/21/2023]
Abstract
PURPOSE To compare multi-slice (MS) MRI sequences of the pelvis acquired at rest and straining to dynamic midsagittal single-slice (SS) sequences for the assessment of pelvic organ prolapse (POP). METHODS This IRB-approved prospective single-center feasibility study included 23 premenopausal symptomatic patients with POP and 22 asymptomatic nulliparous volunteers. MRI of the pelvis at rest and straining was performed with midsagittal SS and MS sequences. Straining effort, visibility of organs and POP grade were scored on both. Organ points (bladder, cervix, anorectum) were measured. Differences between SS and MS sequences were compared with Wilcoxon test. RESULTS Straining effort was good in 84.4% on SS and in 64.4% on MS sequences (p = 0.003). Organ points were always visible on MS sequences, whereas the cervix was not fully visible in 31.1-33.3% on SS sequences. At rest, there were no statistically significant differences of organ point measurements between SS and MS sequences in symptomatic patients. At straining, positions of bladder, cervix, and anorectum were + 1.1 cm (± 1.8 cm), - 0.7 cm (± 2.9 cm), and + 0.7 cm (± 1.3 cm) on SS and + 0.4 mm (± 1.7 cm), - 1.4 cm (± 2.6 cm), and + 0.4 cm (± 1.3 cm) on MS sequences (p < 0.05). Only 2 cases of higher-grade POP were missed on MS sequences (both with poor straining effort). CONCLUSION MS sequences increase the visibility of organ points compared to SS sequences. Dynamic MS sequences can depict POP if images are acquired with sufficient straining effort. Further work is needed to optimize the depiction of the maximum straining effort with MS sequences.
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Affiliation(s)
- Soleen Ghafoor
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Stephan M Beintner-Skawran
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Gian Stöckli
- Department of Gynecology, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Cornelia Betschart
- Department of Gynecology, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Cäcilia S Reiner
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
- University of Zurich, Zurich, Switzerland.
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6
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Guo M, Zbar AP, Wu Y. Imaging the levator ani and the puborectalis muscle: implications in understanding regional anatomy, physiology and pathology. Scand J Gastroenterol 2023; 58:1295-1308. [PMID: 37309141 DOI: 10.1080/00365521.2023.2220458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/17/2023] [Accepted: 05/28/2023] [Indexed: 06/14/2023]
Abstract
Purpose:To review the findings of recent dynamic imaging of the levator ani muscle in order to explain its function during defecation. Historical anatomical studies have suggested that the levator ani initiates defecation by lifting the anal canal, with conventional dissections and static radiologic imagery having been equated with manometry and electromyography.Materials and methods:An analysis of the literature was made concerning the chronological development of imaging modalities specifically designed to assess pelvic floor dynamics. Comparisons are made between imaging and electromyographic data at rest and during provocative manoeuvres including squeeze and strain.Results:The puborectalis muscle is shown distinctly separate from the levator ani and the deep external anal sphincter. In contrast to conventional teaching that the levator ani initiates defecation by lifting the anus, dynamic illustration defecography (DID) has confirmed that the abdominal musculature and the diaphragm instigate defecation with the transverse and vertical component portions of the levator ani resulting in descent of the anus. Current imaging has shown a tendinous peripheral structure to the termination of the conjoint longitudinal muscle, clarifying the anatomy of the perianal spaces. Planar oXy defecography has established patterns of movement of the anorectal junction that separate controls from those presenting with descending perineum syndrome or with anismus (paradoxical puborectalis spasm).Conclusions:Dynamic imaging of the pelvic floor (now mostly with MR proctography) has clarified the integral role of the levator ani during defecation. Rather than lifting the rectum, the muscle ensures descent of the anal canal.
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Affiliation(s)
- Maolin Guo
- Department of Radiology, PLA 989 Hospital, Luoyang, P.R. China
| | - Andrew P Zbar
- Department of Neuroscience and Anatomy, University of Melbourne, Melbourne, Australia
| | - Yucen Wu
- Department of Neuroscience and Anatomy, University of Melbourne, Melbourne, Australia
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7
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García-Mejido JA, Ramos-Vega Z, Fernández-Palacín A, Borrero C, Valdivia M, Pelayo-Delgado I, Sainz-Bueno JA. Predictive Model for the Diagnosis of Uterine Prolapse Based on Transperineal Ultrasound. Tomography 2022; 8:1716-1725. [PMID: 35894009 PMCID: PMC9326672 DOI: 10.3390/tomography8040144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/22/2022] [Accepted: 06/30/2022] [Indexed: 11/27/2022] Open
Abstract
We want to describe a model that allows the use of transperineal ultrasound to define the probability of experiencing uterine prolapse (UP). This was a prospective observational study involving 107 patients with UP or cervical elongation (CE) without UP. The ultrasound study was performed using transperineal ultrasound and evaluated the differences in the pubis−uterine fundus distance at rest and with the Valsalva maneuver. We generated different multivariate binary logistic regression models using nonautomated methods to predict UP, including the difference in the pubis−uterine fundus distance at rest and with the Valsalva maneuver. The parameters were added progressively according to their simplicity of use and their predictive capacity for identifying UP. We used two binary logistic regression models to predict UP. Model 1 was based on the difference in the pubis−uterine fundus distance at rest and with the Valsalva maneuver and the age of the patient [AUC: 0.967 (95% CI, 0.939−0.995; p < 0.0005)]. Model 2 used the difference in the pubis−uterine fundus distance at rest and with the Valsalva maneuver, age, avulsion and ballooning (AUC: 0.971 (95% CI, 0.945−0.997; p < 0.0005)). In conclusion, the model based on the difference in the pubis−uterine fundus distance at rest and with the Valsalva maneuver and the age of the patient could predict 96.7% of patients with UP.
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Affiliation(s)
- José Antonio García-Mejido
- Department of Obstetrics and Gynecology, Valme University Hospital, 41014 Seville, Spain; (C.B.); (M.V.); (J.A.S.-B.)
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Seville, 41009 Seville, Spain
- Correspondence: (J.A.G.-M.); (A.F.-P.)
| | - Zenaida Ramos-Vega
- Department of Obstetrics and Gynecology, Nuestra Señora de la Merced Hospital, 41640 Seville, Spain;
| | - Ana Fernández-Palacín
- Biostatistics Unit, Department of Preventive Medicine and Public Health, University of Seville, 41009 Seville, Spain
- Correspondence: (J.A.G.-M.); (A.F.-P.)
| | - Carlota Borrero
- Department of Obstetrics and Gynecology, Valme University Hospital, 41014 Seville, Spain; (C.B.); (M.V.); (J.A.S.-B.)
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Seville, 41009 Seville, Spain
| | - Maribel Valdivia
- Department of Obstetrics and Gynecology, Valme University Hospital, 41014 Seville, Spain; (C.B.); (M.V.); (J.A.S.-B.)
| | - Irene Pelayo-Delgado
- Department of Obstetrics and Gynecology, Ramón y Cajal University Hospital, 28034 Madrid, Spain;
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Alcalá de Henares, 28871 Madrid, Spain
| | - José Antonio Sainz-Bueno
- Department of Obstetrics and Gynecology, Valme University Hospital, 41014 Seville, Spain; (C.B.); (M.V.); (J.A.S.-B.)
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Seville, 41009 Seville, Spain
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Yagi T, Kodama M, Bun M, Shimura H, Sawada K, Endo M, Kimura T. Magnetic resonance imaging evaluation of pelvic floor structure during pregnancy. Eur J Obstet Gynecol Reprod Biol 2021; 264:289-293. [PMID: 34352425 DOI: 10.1016/j.ejogrb.2021.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/07/2021] [Accepted: 07/25/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Among the various risk factors of pelvic floor disorders, pregnancy has been reported to affect the pelvic floor structure; however, not all these effects have been understood yet. The aim of this study is to elucidate how pregnancy affects pelvic floor structure via magnetic resonance imaging (MRI). STUDY DESIGN We conducted a retrospective study between January 2010 and December 2019 to extract clinical records of pregnant and non-pregnant women, who underwent MRI for obstetrical diseases and ovarian benign tumors, respectively. The data on age, body mass index (BMI), complications, gravida, parity, gestational age, and obstetrical history were collected, and pubo-coccygeal line (PCL), pubo-rectal line (PRL), and M line (ML) on their MR images were measured. Statistical analyses were performed with Wilcoxon test, chi-square test, and Kruskal-Wallis test with Steel-Dwass post hoc test as appropriate. Statistical significance was set at P < 0.05. RESULTS We analyzed the reports of 56 (pregnancy group) and 106 women (non-pregnancy group). There was no significant difference in age or BMI, while the obstetric history was significantly different between these groups. Median PCL, PRL, and ML in the pregnancy group were significantly longer than those in the non-pregnancy group (114.1 mm vs. 110.0 mm, P = 0.018; 48.6 mm vs. 41.6 mm, P < 0.0001 and 21.7 mm vs. 10.0 mm, p < 0.0001. respectively). The subgroup analysis of the effect of pregnancy and vaginal delivery (VD) history on changes in these lines revealed that pregnancy-induced PRL increase tended to recover to the reference level of "non-pregnant without VD," but ML increase did not fully recover. CONCLUSION MRI revealed a strong effect of pregnancy on pelvic floor structure.
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Affiliation(s)
- Taro Yagi
- Osaka University Graduate School of Medicine, Department of Obstetrics and Gynecology, 2-2, Yamada-oka, Suita-city, Osaka, Japan.
| | - Michiko Kodama
- Osaka University Graduate School of Medicine, Department of Obstetrics and Gynecology, 2-2, Yamada-oka, Suita-city, Osaka, Japan.
| | - Michiko Bun
- Osaka University Graduate School of Medicine, Department of Obstetrics and Gynecology, 2-2, Yamada-oka, Suita-city, Osaka, Japan
| | - Hiroko Shimura
- Osaka University Graduate School of Medicine, Department of Obstetrics and Gynecology, 2-2, Yamada-oka, Suita-city, Osaka, Japan
| | - Kenjiro Sawada
- Osaka University Graduate School of Medicine, Department of Obstetrics and Gynecology, 2-2, Yamada-oka, Suita-city, Osaka, Japan.
| | - Masayuki Endo
- Osaka University Graduate School of Medicine, Department of Obstetrics and Gynecology, 2-2, Yamada-oka, Suita-city, Osaka, Japan.
| | - Tadashi Kimura
- Osaka University Graduate School of Medicine, Department of Obstetrics and Gynecology, 2-2, Yamada-oka, Suita-city, Osaka, Japan.
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Collins SA, O'Shea M, Dykes N, Ramm O, Edenfield A, Shek KL, van Delft K, Beestrum M, Kenton K. International Urogynecological Consultation: clinical definition of pelvic organ prolapse. Int Urogynecol J 2021; 32:2011-2019. [PMID: 34191102 DOI: 10.1007/s00192-021-04875-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/20/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This segment of Chapter 1 of the International Urogynecology Consultation (IUC) on pelvic organ prolapse (POP) reviews the literature on the clinical definition of POP with the intent of creating standard terminology. METHODS An international group containing nine urogynecologists and one university-based medical librarian performed a search of the literature using pre-specified search terms in PubMed, Embase, and Scopus. Publications were eliminated if not relevant to the clinical definition of POP, and those articles remaining were evaluated for quality using the Specialist Unit for Review Evidence (SURE). The resulting list of articles was used to inform a comprehensive review and creation of the clinical definition of POP. RESULTS The original search yielded 31,931 references, of which 167 were used by the writing group. Ultimately, 78 are referenced in the manuscript. CONCLUSIONS The clinical definition of POP for this review of the literature is: "anatomical prolapse with descent of at least one of the vaginal walls to or beyond the vaginal hymen with maximal Valsalva effort WITH the presence either of bothersome characteristic symptoms, most commonly the sensation of vaginal bulge, or of functional or medical compromise due to prolapse without symptom bother."
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Affiliation(s)
- Sarah A Collins
- Northwestern Feinberg School of Medicine, 250 E. Superior St. Suite 05-2113, Chicago, IL, 60611, USA.
| | - Michele O'Shea
- Department of Obstetrics and Gynecology, Duke University Health System, Raleigh, NC, USA
| | | | - Olga Ramm
- Division of Urogynecology, Department of Obstetrics and Gynecology, Kaiser Permanente East Bay, Alameda, CA, USA
| | - Autumn Edenfield
- Division of Urogynecology, Department of Obstetrics and Gynecology, Medical University of South Carolina, Mt Pleasant, SC, 29464, USA
| | - Ka Lai Shek
- Department of Obstetrics and Gynecology, Liverpool Hospital, University of Western Sydney, Liverpool, NSW, 2170, Australia
| | - Kim van Delft
- Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Molly Beestrum
- Northwestern Feinberg School of Medicine, 250 E. Superior St. Suite 05-2113, Chicago, IL, 60611, USA
| | - Kimberly Kenton
- Northwestern Feinberg School of Medicine, 250 E. Superior St. Suite 05-2113, Chicago, IL, 60611, USA
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Korula DR, Chandramohan A, John R, Eapen A. Barium Defecating Proctography and Dynamic Magnetic Resonance Proctography: Their Role and Patient's Perception. J Clin Imaging Sci 2021; 11:31. [PMID: 34221640 PMCID: PMC8247951 DOI: 10.25259/jcis_56_2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/02/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives: The objectives of the study were to compare the imaging findings and patient’s perception of barium defecating proctography and dynamic magnetic resonance (MR) proctography in patients with pelvic floor disorders. Material and Methods: This is a prospective study conducted on patients with pelvic floor disorders who consented to undergo both barium proctography and dynamic MR proctography. Imaging findings of both the procedures were compared. Inter-observer agreement (IOA) for key imaging features was assessed. Patient’s perception of these procedures was assessed using a short questionnaire and a visual analog scale. Results: Forty patients (M: F =19:21) with a mean age of 43.65 years and range of 21–75 years were included for final analysis. Mean patient experience score was significantly better for MR imaging (MRI) (p < 0.001). However, patients perceived significantly higher difficulty in rectal evacuation during MRI studies (p = 0.003). While significantly higher number of rectoceles (p = 0.014) were diagnosed on MRI, a greater number of pelvic floor descent (p = 0.02) and intra-rectal intussusception (p = 0.011) were diagnosed on barium proctography. The IOA for barium proctography was substantial for identifying rectoceles, rectal prolapse and for determining M line, p < 0.001. There was excellent IOA for MRI interpretation of cystoceles, peritoneoceles, and uterine prolapse and substantial to excellent IOA for determining anal canal length and anorectal angle, p < 0.001. The mean study time for the barium and MRI study was 12 minutes and 15 minutes, respectively. Conclusion: Barium proctography was more sensitive than MRI for detecting pelvic floor descent and intrarectal intussusception. Although patients perceived better rectal emptying with barium proctography, the overall patient experience was better for dynamic MRI proctography.
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Affiliation(s)
| | | | - Reetu John
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anu Eapen
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
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11
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Clinical applications of pelvic floor imaging: opinion statement endorsed by the society of abdominal radiology (SAR), American Urological Association (AUA), and American Urogynecologic Society (AUGS). Abdom Radiol (NY) 2021; 46:1451-1464. [PMID: 33772614 DOI: 10.1007/s00261-021-03017-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/21/2021] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
Pelvic floor dysfunction is prevalent, with multifactorial causes and variable clinical presentations. Accurate diagnosis and assessment of the involved structures commonly requires a multidisciplinary approach. Imaging is often complementary to clinical assessment, and the most commonly used modalities for pelvic floor imaging include fluoroscopic defecography, magnetic resonance defecography, and pelvic floor ultrasound. This collaboration opinion paper was developed by representatives from multiple specialties involved in care of patients with pelvic floor dysfunction (radiologists, urogynecologists, urologists, and colorectal surgeons). Here, we discuss the utility of imaging techniques in various clinical scenarios, highlighting the perspectives of referring physicians. The final draft was endorsed by the Society of Abdominal Radiology (SAR), American Urogynecologic Society (AUGS), and the American Urological Association (AUA).
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Abstract
Pelvic floor dysfunction is a relatively common but often complex condition, presenting with a variety of clinical symptoms, especially when it involves multiple compartments. Clinical exam alone is often inadequate and requires a complementary imaging study. Magnetic resonance defecography (MRD) is an excellent noninvasive diagnostic study with its multiplanar capability, lack of ionizing radiation and excellent soft tissue resolution. It can identify both anatomic and functional abnormalities in the pelvic floor and specifically excels in its ability to simultaneously detect multicompartmental pathology and help with vital pre-operative assessment. This manuscript reviews the relevant anatomical landmarks, describes the optimal technique, highlights an approach to the interpretation of MRD, and provides an overview of the various pelvic floor disorders in the different anatomical compartments.
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Abstract
The pelvic floor is composed of a network of muscles, ligaments, and fasciae, which provide active and passive support for the pelvic organs. Impairment of these pelvic floor elements can result in a variety of functional abnormalities and single or multicompartment organ prolapse. Knowledge of normal pelvic floor anatomy can aid the radiologist in understanding the complex nature of pelvic floor dysfunction and is important for comprehensive image interpretation. This article provides an overview of normal anatomy of the pelvic floor as seen on magnetic resonance imaging, ultrasound, and fluoroscopic studies performed in the evaluation of pelvic floor function.
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Flusberg M, Xi Y, Jambhekar K, Bahrami S, Chernyak V, Lalwani N, Lockhart M, Ram R, Fielding JR, El Sayed RF, Khatri G. Variability in utilization and techniques of pelvic floor imaging: findings of the SAR pelvic floor dysfunction disease-focused panel. Abdom Radiol (NY) 2021; 46:1294-1301. [PMID: 33585965 DOI: 10.1007/s00261-021-02957-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/11/2021] [Accepted: 01/15/2021] [Indexed: 11/26/2022]
Abstract
Pelvic floor disorders are common and can negatively impact quality of life. Imaging of patients with pelvic floor disorders has been extremely heterogeneous between institutions due in part to variations in clinical expectations, technical considerations, and radiologist experience. In order to assess variations in utilization and technique of pelvic floor imaging across practices, the society of abdominal radiology (SAR) disease-focused panel on pelvic floor dysfunction developed and administered an online survey to radiologists including the SAR membership. Results of the survey were compared with published recommendations for pelvic floor imaging to identify areas in need of further standardization. MRI was the most commonly reported imaging technique for pelvic floor imaging followed by fluoroscopic defecography. Ultrasound was only used by a small minority of responding radiologists. The survey responses demonstrated variability in imaging utilization, patient referral patterns, imaging protocols, patient education, and interpretation and reporting of pelvic floor imaging examinations. This survey highlighted inconsistencies in technique between institutions as well as potential gaps in knowledge that should be addressed to standardize evaluation of patients with pelvic floor dysfunction.
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Affiliation(s)
- Milana Flusberg
- Westchester Medical Center, 100 Woods Rd, Valhalla, NY, 10595, USA.
| | - Yin Xi
- University of Texas Southwestern Medical Center, Dallas, USA
| | - Kedar Jambhekar
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Simin Bahrami
- University of California Los Angeles, Los Angeles, CA, USA
| | | | - Neeraj Lalwani
- Wake Forest University Baptist Medical Center, Winston-Salem, USA
| | - Mark Lockhart
- University of Alabama Medical Center, Birmingham, USA
| | - Roopa Ram
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | | | - Gaurav Khatri
- University of Texas Southwestern Medical Center, Dallas, USA
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Santos Junior LC, Brito LGO, Castro EBD, Dertkigil S, Juliato CRT. Mid- to Long-Term Magnetic Resonance Imaging Results of Two Prolapse Surgeries for Apical Defect: A Secondary Analysis of a Randomized Controlled Trial. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:46-53. [PMID: 33513636 PMCID: PMC10183877 DOI: 10.1055/s-0040-1718441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) has been considered another tool for use during the pre- and postoperative periods of the management of pelvic-organ prolapse (POP). However, there is little consensus regarding its practical use for POP and the association between MRI lines of reference and physical examination. We aimed to evaluate the mid- to long-term results of two surgical techniques for apical prolapse. METHODS In total, 40 women with apical POP randomized from 2014 to 2016 underwent abdominal sacrocolpopexy (ASC group; n = 20) or bilateral vaginal sacrospinous fixation with an anterior mesh (VSF-AM group; n = 20). A physical examination using the POP Quantification System (POP-Q) for staging (objective cure) and the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS: subjective cure), were applied and analyzed before and one year after surgery respectively. All MRI variables (pubococcigeous line [PCL], bladder base [BB], anorectal junction [ARJ], and the estimated levator ani subtended volume [eLASV]) were investigated one year after surgery. Significance was established at p < 0.05. RESULTS After a mean 27-month follow-up, according to the MRI criteria, 60% of the women were cured in the VSF-AM group versus 45% in ASC group (p = 0.52). The POP-Q and objective cure rates by MRI were correlated in the anterior vaginal wall (p = 0.007), but no correlation was found with the subjective cure. The eLASV was larger among the patients with surgical failure, and a cutoff of ≥ 33.5 mm3 was associated with postoperative failure (area under the receiver operating characteristic curve [ROC]: 0.813; p = 0.002). CONCLUSION Both surgeries for prolapse were similar regarding the objective variables (POP-Q measurements and MRI cure rates). Larger eLASV areas were associated with surgical failure.
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Affiliation(s)
- Luiz Carlos Santos Junior
- Department of Obstetrics and Gynecology, Pelvic Floor Dysfunction Division, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Luiz Gustavo Oliveira Brito
- Department of Obstetrics and Gynecology, Pelvic Floor Dysfunction Division, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Edilson Benedito de Castro
- Department of Obstetrics and Gynecology, Pelvic Floor Dysfunction Division, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Sergio Dertkigil
- Department of Obstetrics and Gynecology, Pelvic Floor Dysfunction Division, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Cassia Raquel Teatin Juliato
- Department of Obstetrics and Gynecology, Pelvic Floor Dysfunction Division, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
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Shatkin-Margolis A, Duke E, Ghodsi V, Hill A, Crisp CC, Pauls RN. Dynamic magnetic resonance imaging following native tissue vaginal reconstructive surgery; a prospective study. Int Urogynecol J 2020; 32:1519-1525. [PMID: 33089350 DOI: 10.1007/s00192-020-04571-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/14/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To describe the impact of native tissue vaginal reconstruction on pelvic anatomy using dynamic magnetic resonance imaging. METHODS This prospective single-cohort observational study involved women undergoing native tissue reconstruction with intraperitoneal vaginal vault suspension for pelvic organ prolapse. Concomitant procedures such as hysterectomy, midurethral sling, and anterior or posterior colporrhaphy were allowed. Enrolled participants underwent dynamic pelvic imaging pre- and postoperatively. Radiographic and anatomic measurements were compared. Secondary outcomes included validated patient questionnaires. RESULTS Fourteen participants were included in the analysis. The mean age was 62 years; all participants were Caucasian. Most participants had stage III pelvic organ prolapse. Significant improvements were noted in several radiographic measurements. The average H-line (representing levator hiatus width) with straining maneuvers improved following surgery (7.2 cm preoperatively vs. 6.6 cm postoperatively, p = 0.015). The average M-line (representing levator muscular descent) improved significantly with both straining (4.0 cm preoperatively vs. 3.0 cm postoperatively, p < 0.001) and defecatory maneuvers (6.2 cm preoperatively vs. 5.2 cm postoperatively, p = 0.001). The average size of cystocele improved from 5.6 cm (moderate) preoperatively to 0.7 cm (absent descent) postoperatively (p < 0.001). The average descent of the vaginal apex with defecation preoperatively was 3.0 cm (moderate) and 0 cm (absent descent) postoperatively (p = 0.003). Posterior compartment descent with defecation did not change following surgical intervention (5.8 cm preoperatively vs. 5.2 cm postoperatively, p = 0.056). Pelvic Organ Prolapse Quantification measurements improved in all compartments, and Pelvic Floor Distress Inventory-20 scores improved significantly following surgery (102 preoperatively vs. 30 postoperatively, p < 0.001). CONCLUSIONS Native tissue reconstruction with intraperitoneal vaginal vault suspension resulted in significant anatomic improvements, as defined by physical examination and dynamic magnetic resonance imaging.
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Affiliation(s)
- Abigail Shatkin-Margolis
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, Good Samaritan Hospital TriHealth, Cincinnati, OH, USA. .,Kaiser Permanente - Dublin Medical Offices & Cancer Center, 3100 Dublin Blvd., Dublin, CA, 94568, USA.
| | - Eugene Duke
- Department of Radiology, Good Samaritan Hospital TriHealth, Cincinnati, OH, USA
| | - Vivian Ghodsi
- Division of Female Pelvic Medicine and Reconstructive Surgery, TriHealth Hatton Research Institute, Cincinnati, OH, USA
| | - Austin Hill
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, Good Samaritan Hospital TriHealth, Cincinnati, OH, USA
| | - Catrina C Crisp
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, Good Samaritan Hospital TriHealth, Cincinnati, OH, USA
| | - Rachel N Pauls
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, Good Samaritan Hospital TriHealth, Cincinnati, OH, USA
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Komemushi Y, Komemushi A, Morimoto K, Yoneda Y, Yoshimura R, Tanaka T, Katou T, Nakatani T. Quantitative evaluation of age-related changes to pelvic floor muscles in magnetic resonance images from 369 patients. Geriatr Gerontol Int 2019; 19:834-837. [PMID: 31270946 DOI: 10.1111/ggi.13726] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/17/2019] [Accepted: 06/04/2019] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to establish and validate a quantitative evaluation method for pelvic floor muscles using magnetic resonance images (MRI) and to examine the morphological change of pelvic floor muscles with aging. METHODS Data from 369 consecutive patients (163 men, 206 women; median age 58 years; range 17-92 years) who underwent coronal T2-weighted pelvic MRI at Osaka General Hospital between January 2016 and December 2016 were retrospectively examined. MRI of the levator ani muscle was evaluated. The MRI image blinded the patient information and was evaluated by a radiology specialist with 22 years of experience. In coronal T2-weighted MRI of the pelvis, the levator ani muscle was evaluated using the slice; it showed the most upward and downward convexity. We measured the thickness of the levator ani muscle, and the distance at the most convex part from a straight line connecting the origin and insertion of the levator ani muscle on both the left and right sides. Upward and downward convexity was recorded in positive and negative values, respectively. RESULTS The levator ani muscle was able to be evaluated quantitatively in all cases. Both men and women showed thinning (men: mean 3.316 mm, r = -0.388, P < 0.0001; women: mean 3.947 mm, r = -0.359, P < 0.0001) and concavity (men: mean 1.412 mm, r = -0.362, P < 0.0001; women: mean 4.979 mm, r = -0.630, P < 0.0001) of the levator ani muscle with aging. CONCLUSIONS A quantitative evaluation method for pelvic floor muscles using MRI was established. Aging was associated with morphological changes in the pelvic floor muscles in both men and women. Geriatr Gerontol Int 2019; 19: 834-837.
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Affiliation(s)
| | - Atsushi Komemushi
- Department of Radiology, Kansai Medical University Medical Center, Osaka, Japan
| | - Kazuya Morimoto
- Department of Urology, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | - Yukio Yoneda
- Department of Urology, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | - Rikio Yoshimura
- Department of Urology, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | - Tomoaki Tanaka
- Department of Urology, Osaka City University, Osaka, Japan
| | - Takeharu Katou
- Department of Radiology, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
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Rostaminia G, Routzong M, Chang C, Goldberg RP, Abramowitch S. Motion of the vaginal apex during strain and defecation. Int Urogynecol J 2019; 31:391-400. [PMID: 31161247 DOI: 10.1007/s00192-019-03981-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/10/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Although the main function of the suspensory ligaments of the vaginal apex is to prevent its descent toward the vaginal introitus, there remains limited information regarding its normal physiological motion. This study was aimed at quantifying the motion of the non-prolapsed vaginal apex during strain and defecation maneuvers. METHODS This study represents a sub-analysis of a parent study that was aimed at evaluating rectal mobility with regard to obstructed defecation symptoms. Patients with normal apical vaginal support who had undergone MR defecography were entered into the study. For each patient, midsagittal images at rest, maximum strain, and maximum evacuation were utilized. The location of the cervicovaginal junction, S4-S5 intervertebral disc, sacral promontory, and hymen were identified. Vectors were calculated from each of these landmarks to the vaginal apex to compare vector angles and magnitudes across subjects. RESULTS Twelve patients were included in this study. At rest, the vagina extends from the hymen, which is inferior and posterior to the inferior symphysis pubis, to the vaginal apex at an angle of 45.2° ± 14.5° relative to the pubococcygeal line. This angle became more acute with strain and even more so during maximum evacuation (14.1° ± 9.0°, p < 0.001). Differences in the vector magnitude, although not statistically significant, showed a trend indicating shorter lengths with maximum evacuation. CONCLUSIONS The vaginal apex is a highly mobile structure demonstrating significantly more mobility during defecation compared with strain. The data obtained contradict the general perception that the vaginal apex is relatively fixed within the pelvis of normally supported women.
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Affiliation(s)
- Ghazaleh Rostaminia
- Female Pelvic Medicine and Reconstructive Surgery (FPMRS), Division of Urogynecology, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, 9650 Gross Point Road, Suite 3900, Skokie, IL, 60076, USA.
| | - Megan Routzong
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cecilia Chang
- NorthShore University HealthSystem Research Institute, Evanston, IL, USA
| | - Roger P Goldberg
- Female Pelvic Medicine and Reconstructive Surgery (FPMRS), Division of Urogynecology, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, 9650 Gross Point Road, Suite 3900, Skokie, IL, 60076, USA
| | - Steven Abramowitch
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
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Juliato CRT, Santos‐Junior LC, Castro EB, Dertkigil SS, Brito LGO. Vaginal axis after abdominal sacrocolpopexy versus vaginal sacrospinous fixation—a randomized trial. Neurourol Urodyn 2019; 38:1142-1151. [DOI: 10.1002/nau.23970] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/10/2019] [Accepted: 02/20/2019] [Indexed: 12/19/2022]
Affiliation(s)
| | - Luiz Carlos Santos‐Junior
- Department of Obstetrics and Gynecology, School of Medical SciencesUniversity of CampinasSão Paulo Brazil
| | - Edilson Benedito Castro
- Department of Obstetrics and Gynecology, School of Medical SciencesUniversity of CampinasSão Paulo Brazil
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Abstract
Pelvic floor disorders (PFDs) are a common and complex problem encompassing a broad spectrum of conditions such as urinary incontinence, voiding difficulties, pelvic organ prolapse, anal incontinence, and chronic pelvic pain. The initial assessment of women with PFDs is based on a detailed and focused history and a holistic clinical evaluation of the pelvic floor. Other investigations may be used in clinical practice for the determination of the pathophysiology and the severity of the PFDs. In the field of urogynecology, urodynamic studies, ultrasound, and magnetic resonance imaging of the pelvic floor are currently implemented in the diagnostic work-up of women with PFDs. These provide valuable information not only on the anatomic integrity but also on the function of the pelvic floor which may not be apparent from the clinical examination. The provision of such information is complementary to the patient's symptoms and degree of bother and enables the implementation of a targeted treatment plan, thus maximizing the likelihood of cure and minimizing the risk of treatment complications.
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Affiliation(s)
- T Grigoriadis
- a Urogynecology Department , National and Kapodistrian University of Athens, 'Alexandra' Hospital , Athens , Greece
| | - S Athanasiou
- a Urogynecology Department , National and Kapodistrian University of Athens, 'Alexandra' Hospital , Athens , Greece
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Gupta AP, Pandya PR, Nguyen ML, Fashokun T, Macura KJ. Use of Dynamic MRI of the Pelvic Floor in the Assessment of Anterior Compartment Disorders. Curr Urol Rep 2018; 19:112. [PMID: 30421087 DOI: 10.1007/s11934-018-0862-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE OF REVIEW Approximately 25% of women in the USA suffer from pelvic floor disorders. Disorders of the anterior compartment of the pelvic floor, in particular, can cause symptoms such as incomplete urinary voiding, urinary incontinence, pelvic organ prolapse, dyspareunia, and pelvic pain, potentially negatively impacting a woman's quality of life. In some clinical situations, clinical exam alone may be insufficient, especially when patient's symptoms are in excess of their pelvic exam findings. In many of these patients, dynamic magnetic resonance imaging (dMRI) of the pelvic floor can be a valuable imaging tool allowing for comprehensive assessment of the entire pelvic anatomy and its function. RECENT FINDINGS Traditionally, evaluation of the anterior compartment has been primarily through clinical examination with occasional use of urodynamic testing and ultrasound. In recent years, dMRI has continued to gain popularity due to its improved imaging quality, reproducibility, and ability to display the entire pelvic floor. Emerging evidence has also shown utility of dMRI in the postoperative setting. In spite of advances, there remains an ongoing discussion in contemporary literature regarding the accuracy of dMRI and its correlation with clinical examination and with patient symptoms. Dynamic pelvic MRI is a helpful adjunct to physical examination and urodynamic testing, particularly when a patient's symptoms are in excess of the physical examination findings. Evaluation with dMRI can guide preoperative and postoperative surgical management in many patients, especially in the setting of multicompartmental disorders. This review will summarize relevant pelvic floor anatomy and discuss the clinical application, imaging technique, imaging interpretation, and limitations of dMRI.
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Affiliation(s)
- Ayushi P Gupta
- Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 601 N. Caroline Street, JHOC 3140C, Baltimore, MD, 21287, USA. .,Department of Radiology and Imaging Sciences, Division of Abdominal Imaging, Emory University School of Medicine, 1365-A Clifton Road NE, Suite AT-627, Atlanta, GA, 30322, USA.
| | - Prerna Raj Pandya
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Johns Hopkins University School of Medicine, 301 Building, Suite 3200, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - My-Linh Nguyen
- Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 601 N. Caroline Street, JHOC 3140C, Baltimore, MD, 21287, USA.,Department of Imaging Services, Mid-Atlantic Permanente Medical Group, 2101 E. Jefferson Street, Rockville, MD, 20852, USA
| | - Tola Fashokun
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Sinai Hospital of Baltimore, 2411 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Katarzyna J Macura
- Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 601 N. Caroline Street, JHOC 3140C, Baltimore, MD, 21287, USA
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Lin FC, Funk JT, Tiwari HA, Kalb BT, Twiss CO. Dynamic Pelvic Magnetic Resonance Imaging Evaluation of Pelvic Organ Prolapse Compared to Physical Examination Findings. Urology 2018; 119:49-54. [PMID: 29944912 DOI: 10.1016/j.urology.2018.05.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 05/17/2018] [Accepted: 05/22/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare dynamic magnetic resonance imaging (dMRI) defecography phase findings with physical examination (PE) grading in the evaluation of pelvic organ prolapse (POP). METHODS We retrospectively reviewed 274 consecutive patients who underwent dMRI with defecography. Baden-Walker grading of POP, absolute dMRI values, and grading by dMRI were collected for anterior, apical, and posterior compartments. Anatomically significant POP on PE was defined as Baden-Walker Grade ≥3 and on dMRI by dMRI Grade ≥2. A Spearman's Rank correlation was performed between absolute dMRI values and respective POP grades. RESULTS A total of 178 female patients were included. Anatomically insignificant and significant cystoceles had a 26.4% (19/72) and 84.6% (66/78) agreement respectively. Anatomically insignificant and significant apical prolapse had a 2.0% (2/100) and 62.9% (17/27) agreement respectively. Anatomically insignificant and significant posterior prolapse had a 49.5% (51/103) and 78.7% (59/75) agreement respectively. PE detected only 30% (9/30) of total dMRI detected enteroceles and misdiagnosed 10% (3/30) of these patients with a rectocele. CONCLUSION The dMRI defecography phase correlated well for anatomically significant prolapse in anterior and posterior compartments. dMRI was superior to PE for enterocele detection and was better able to distinguish an enterocele from a rectocele. Thus, dMRI may have the greatest diagnostic value in cases where the presence of an enterocele is unclear in apical and/or posterior compartments.
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Affiliation(s)
- Frank C Lin
- University of Arizona, College of Medicine, Division of Urology, Tucson, AZ.
| | - Joel T Funk
- University of Arizona, College of Medicine, Division of Urology, Tucson, AZ
| | - Hina Arif Tiwari
- University of Arizona, College of Medicine, Department of Medical Imaging, Tucson, AZ
| | - Bobby T Kalb
- University of Arizona, College of Medicine, Department of Medical Imaging, Tucson, AZ
| | - Christian O Twiss
- University of Arizona, College of Medicine, Division of Urology, Tucson, AZ
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Abdulaziz M, Kavanagh A, Stothers L, Macnab AJ. Relevance of open magnetic resonance imaging position (sitting and standing) to quantify pelvic organ prolapse in women. Can Urol Assoc J 2018; 12:E453-E460. [PMID: 29989885 DOI: 10.5489/cuaj.5186] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In pelvic organ prolapse (POP), posture and gravity impact organ position and symptom severity. The advanced magnet configuration in open magnetic resonance imaging (MRO) allows patients to be imaged when sitting and standing, as well in a conventional supine position. This study evaluated if sitting and standing MRO images are relevant as a means of improving quantification of POP because they allow differences in organ position not seen on supine imaging to be identified. METHODS Forty women recruited from a university urogynecology clinic had MRO imaging (0.5 T scanner) with axial and sagittal T2-weighted pelvic scans obtained when sitting, standing, and supine. Pelvic reference lines were used to quantify the degree of POP, and the relevance of imaging position on the detection of POP compared. RESULTS Images from 40 participants were evaluated (20 with POP and 20 asymptomatic controls). Our results indicate that the maximal extent of prolapse is best evaluated in the standing position using H line, M line, mid-pubic line, and perineal line as reference lines to determine POP. CONCLUSIONS MRO imaging of symptomatic patients in a standing position is relevant in the quantification of POP. Compared with supine images, standing imaging identifies that greater levels of downward movement in the anterior and posterior compartments occur, presumably under the influence of posture and gravity. In contrast, no appreciable benefit was afforded by imaging in the sitting position, which precluded use of some reference lines due to upward movement of the anorectal junction.
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Affiliation(s)
- Marwa Abdulaziz
- PhD Candidate, Department of Experimental Medicine, Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Alex Kavanagh
- Department of Urologic Sciences, University of British Columbia, and Principal Investigator, International Collaboration on Repair Discovery (ICORD), Blusson Spinal Cord Centre, Vancouver, BC, Canada
| | - Lynn Stothers
- Stellenbosch Institute for Advanced Study, Wallenberg Research Centre at Stellenbosch University, Stellenbosch, South Africa
| | - Andrew J Macnab
- Department of Urologic Sciences, University of British Columbia, and Principal Investigator, International Collaboration on Repair Discovery (ICORD), Blusson Spinal Cord Centre, Vancouver, BC, Canada.,Stellenbosch Institute for Advanced Study, Wallenberg Research Centre at Stellenbosch University, Stellenbosch, South Africa
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Nekooeimehr I, Lai-Yuen S, Bao P, Weitzenfeld A, Hart S. Automated contour tracking and trajectory classification of pelvic organs on dynamic MRI. J Med Imaging (Bellingham) 2018; 5:014008. [PMID: 29651450 DOI: 10.1117/1.jmi.5.1.014008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 03/12/2018] [Indexed: 11/14/2022] Open
Abstract
A method is presented to automatically track and segment pelvic organs on dynamic magnetic resonance imaging (MRI) followed by multiple-object trajectory classification to improve understanding of pelvic organ prolapse (POP). POP is a major health problem in women where pelvic floor organs fall from their normal position and bulge into the vagina. Dynamic MRI is presently used to analyze the organs' movements, providing complementary support for clinical examination. However, there is currently no automated or quantitative approach to measure the movement of the pelvic organs and their correlation with the severity of prolapse. In the proposed method, organs are first tracked and segmented using particle filters and [Formula: see text]-means clustering with prior information. Then, the trajectories of the pelvic organs are modeled using a coupled switched hidden Markov model to classify the severity of POP. Results demonstrate that the presented method can automatically track and segment pelvic organs with a Dice similarity index above 78% and Hausdorff distance of [Formula: see text] for 94 tested cases while demonstrating correlation between organ movement and POP. This work aims to enable automatic tracking and analysis of multiple deformable structures from images to improve understanding of medical disorders.
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Affiliation(s)
| | - Susana Lai-Yuen
- University of South Florida, Department of Industrial and Management Systems Engineering, Tampa, Florida, United States
| | - Paul Bao
- University of South Florida, Department of Computer Science and Engineering, Tampa, Florida, United States
| | - Alfredo Weitzenfeld
- University of South Florida, Department of Computer Science and Engineering, Tampa, Florida, United States
| | - Stuart Hart
- University of South Florida, Department of Obstetrics and Gynecology, Tampa, Florida, United States.,Medtronic, Tampa, Florida, United States
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25
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Kobi M, Flusberg M, Paroder V, Chernyak V. Practical guide to dynamic pelvic floor MRI. J Magn Reson Imaging 2018; 47:1155-1170. [PMID: 29575371 DOI: 10.1002/jmri.25998] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 02/13/2018] [Indexed: 01/23/2023] Open
Abstract
Pelvic floor dysfunction encompasses a spectrum of functional disorders that result from impairment of the ligaments, fasciae, and muscles supporting the pelvic organs. It is a prevalent disorder that carries a lifetime risk over 10% for undergoing a surgical repair. Pelvic floor weakness presents as a wide range of symptoms, including pain, pelvic pressure or bulging, urinary and fecal incontinence, constipation, and sexual dysfunction. A correct diagnosis by clinical examination alone can be challenging, particularly in cases involving multiple compartments. Magnetic resonance imaging (MRI) allows noninvasive, radiation-free, high soft-tissue resolution evaluation of all three pelvic compartments, and has proved a reliable technique for accurate diagnosis of pelvic floor dysfunction. MR defecography with steady-state sequences allows detailed anatomic and functional evaluation of the pelvic floor. This article provides an overview of normal anatomy and function of the pelvic floor and discusses a practical approach to the evaluation of imaging findings of pelvic floor relaxation, pelvic organ prolapse, fecal incontinence, and obstructed defecation. LEVEL OF EVIDENCE 5 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1155-1170.
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Affiliation(s)
- Mariya Kobi
- Department of Radiology, Montefiore Medical Center, Bronx, New York, USA
| | - Milana Flusberg
- Department of Radiology, Montefiore Medical Center, Bronx, New York, USA
| | - Viktoriya Paroder
- Department of Radiology, Memorial Sloan Kettering Center, New York, New York, USA
| | - Victoria Chernyak
- Department of Radiology, Montefiore Medical Center, Bronx, New York, USA
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Khatri G, de Leon AD, Lockhart ME. MR Imaging of the Pelvic Floor. Magn Reson Imaging Clin N Am 2017; 25:457-480. [DOI: 10.1016/j.mric.2017.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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27
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Reiner CS, Williamson T, Winklehner T, Lisse S, Fink D, DeLancey JOL, Betschart C. The 3D Pelvic Inclination Correction System (PICS): A universally applicable coordinate system for isovolumetric imaging measurements, tested in women with pelvic organ prolapse (POP). Comput Med Imaging Graph 2017; 59:28-37. [PMID: 28609701 DOI: 10.1016/j.compmedimag.2017.05.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 05/19/2017] [Accepted: 05/30/2017] [Indexed: 01/03/2023]
Abstract
In pelvic organ prolapse (POP), the organs are pushed downward along the lines of gravity, so measurements along this longitudinal body axis are desirable. We propose a universally applicable 3D coordinate system that corrects for changes in pelvic inclination and that allows the localization of any point in the pelvis at rest or under dynamic conditions on magnetic resonance images (MRI) of pelvic floor disorders in a scanner- and software independent manner. The proposed 3D coordinate system called 3D Pelvic Inclination Correction System (PICS) is constructed utilizing four bony landmark points, with the origin set at the inferior pubic point, and three additional points at the sacrum (sacrococcygeal joint) and both ischial spines, which are clearly visible on MRI images. The feasibility and applicability of the moving frame was evaluated using MRI datasets from five women with pelvic organ prolapse, three undergoing static MRI and two undergoing dynamic MRI of the pelvic floor in a supine position. The construction of the coordinate system was performed utilizing the selected landmarks, with an initial implementation completed in MATLAB. In all cases the selected landmarks were clearly visible, with the construction of the 3D PICS and measurement of pelvic organ positions performed without difficulty. The resulting distance from the organ position to the horizontal PICS plane was compared to a traditional measure based on standard measurements in 2D slices. The two approaches demonstrated good agreement in each of the cases. The developed approach makes quantitative assessment of pelvic organ position in a physiologically relevant 3D coordinate system possible independent of pelvic movement relative to the scanner. It allows the accurate study of the physiologic range of organ location along the body axis ("up or down") as well as defects of the pelvic sidewall or birth-related pelvic floor injuries outside the midsagittal plane, not possible before in a 2D reference line system. Measures in 3D can be monitored over time and may reveal pathology before bothersome symptoms appear, as well as allowing comparison of outcomes between different patient pools after different surgical approaches.
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Affiliation(s)
- Caecilia S Reiner
- Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
| | | | | | - Sean Lisse
- Pelvic Floor Research Group, University of Michigan, Ann Arbor, MI, USA
| | - Daniel Fink
- University of Zurich, Zurich, Switzerland; Department of Gynecology, University Hospital of Zurich, Zurich, Switzerland
| | - John O L DeLancey
- Pelvic Floor Research Group, University of Michigan, Ann Arbor, MI, USA
| | - Cornelia Betschart
- University of Zurich, Zurich, Switzerland; Pelvic Floor Research Group, University of Michigan, Ann Arbor, MI, USA; Department of Gynecology, University Hospital of Zurich, Zurich, Switzerland.
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Cimsit C, Yoldemir T, Akpinar IN. Prevalence of dynamic magnetic resonance imaging-identified pelvic organ prolapse in pre- and postmenopausal women without clinically evident pelvic organ descent. Acta Radiol 2016; 57:1418-1424. [PMID: 26041768 DOI: 10.1177/0284185115589123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Dynamic magnetic resonance imaging (dMRI) is an imaging tool that can be used to evaluate and stage pelvic organ prolapse (POP). Greater understanding of the incidental detection of POP in asymptomatic patients is needed. Purpose To evaluate the prevalence of dMRI-detected POP in pre-and postmenopausal women who were imaged for reasons unrelated to pelvic floor dysfunction. Material and Methods A total of 227 women who had diagnoses that did not include POP underwent abdominal/pelvic dMRI. Patients with a positive gynecological examination for or a clinical history of POP ( n = 11), hysterectomy ( n = 4), or gynecologic-oncology surgery ( n = 2) were excluded, as well as patients who were unable to strain during MRI ( n = 11). A total of 199 patients without visible prolapse were enrolled in the study. An H-line, M-line, pubococcygeal line (PCL), and mid-pubic line (MPL) were used to detect and grade prolapse. Results The prevalence of dMRI-identified POP was higher in postmenopausal subjects. The PCL led to a greater frequency of prolapse detection than the MPL. The frequency of middle compartment descent was similar regardless of whether the PCL or MPL was used as a reference line. There was a higher incidence of prolapse in the posterior compartment. Using an H-line and PCL as references, the anterior and posterior compartments were found to significantly differ between pre- and postmenopausal subjects. The MRI parameters that were used to define POP were not correlated with parity, vaginal birth, BMI, or fetal birth weight. With respect to the MPL, age was correlated with both the presence of an elongated H-line and with descent. Conclusion Dynamic MRI identified incidental pelvic organ prolapse in asymptomatic patients. The prevalence of dMRI-detected POP was higher in postmenopausal women without visible prolapse. These findings suggest the need for further studies to identify how to modify the currently used dMRI thresholds for postmenopausal women.
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Affiliation(s)
- Canan Cimsit
- Department of Radiology, Marmara University Training and Research Hospital, Istanbul, Turkey
| | - Tevfik Yoldemir
- Department of Obstetrics and Gynaecology, Marmara University Training and Research Hospital, Istanbul, Turkey
| | - Ihsan Nuri Akpinar
- Department of Radiology, Marmara University Training and Research Hospital, Istanbul, Turkey
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Hassan HHM, Elnekiedy AM, Elshazly WG, Naguib NN. Modified MR defecography without rectal filling in obstructed defecation syndrome: Initial experience. Eur J Radiol 2016; 85:1673-81. [DOI: 10.1016/j.ejrad.2016.06.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/20/2016] [Accepted: 06/20/2016] [Indexed: 10/21/2022]
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Ismail S, Duckett J, Rizk D, Sorinola O, Kammerer-Doak D, Contreras-Ortiz O, Al-Mandeel H, Svabik K, Parekh M, Phillips C. Recurrent pelvic organ prolapse: International Urogynecological Association Research and Development Committee opinion. Int Urogynecol J 2016; 27:1619-1632. [DOI: 10.1007/s00192-016-3076-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 06/14/2016] [Indexed: 12/13/2022]
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Prospective Comparison between two different magnetic resonance defecography techniques for evaluating pelvic floor disorders: air-balloon versus gel for rectal filling. Eur Radiol 2015; 26:1783-91. [DOI: 10.1007/s00330-015-4016-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/18/2015] [Accepted: 09/07/2015] [Indexed: 10/23/2022]
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Brocker KA, Alt CD, Rzepka J, Sohn C, Hallscheidt P. One-year dynamic MRI follow-up after vaginal mesh repair: evaluation of clinical, radiological, and quality-of-life results. Acta Radiol 2015; 56:1002-8. [PMID: 25136056 DOI: 10.1177/0284185114544241] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 06/20/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pelvic organ prolapse (POP) is a common disorder in elderly women often surgically repaired with alloplastic meshes; yet knowledge of the pelvic floor behavior and multi-compartment defects postoperatively is scarce. PURPOSE To evaluate the 1-year outcome after mesh repair in patients with POP using clinical examination (CE), dynamic magnetic resonance imaging (dMRI), and the prolapse quality-of-life (P-QOL) questionnaire. MATERIAL AND METHODS A prospective observational study was conducted of 69 women undergoing pelvic mesh surgery. Clinical examination, dMRI, and the P-QOL questionnaire were applied before and after surgery to evaluate POP. Mean outcome measures were POP outcome as determined on clinical and dMRI examinations and its impact on quality of life. Statistical results were obtained with SPSS version 15.0. ANOVA was used to compare pre-/postsurgical quality of life data. RESULTS Sixty-nine women (mean age, 64.75 years; BMI, 26.75 kg/m(2); postmenopausal, 89.2%) were recruited and treated with Seratom® or Perigee™ mesh implants. A significant improvement in the position of bladder neck, vaginal vault/uterus, pouch of Douglas, and rectum was found 12 weeks and 1 year after surgery using POP-Q scale and dMRI. Advanced cystoceles and enteroceles seem underestimated by CE using the POP-Q system compared to dMRI results (P = 0.003 and P < 0.001), vice versa dMRI overestimated POP compared to CE. Sixty-four women completed the P-QOL questionnaire, presenting reduced quality of life before surgery which improves postsurgically. Prolapse impact and physical, social, and role limitations correlated strongest with a low quality of life (P < 0.001). CONCLUSION The 1-year follow-up after mesh repair showed statistical and clinical improvement for all tools employed. dMRI seems a reliable tool for simultaneous assessment of defects in all three compartments, but tends to overestimate POP compared to clinical examination.
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Affiliation(s)
- Kerstin A Brocker
- Department of Obstetrics and Gynecology, University of Heidelberg, Medical School, Heidelberg, Germany
| | - Celine D Alt
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Medical School, Heidelberg, Germany
| | - Jakub Rzepka
- Department of Obstetrics and Gynecology, Medical Center of Postgraduate Education, Warsaw, Poland
| | - Christof Sohn
- Department of Obstetrics and Gynecology, University of Heidelberg, Medical School, Heidelberg, Germany
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Soljanik I, Brocker K, Solyanik O, Stief CG, Anding R, Kirschner-Hermanns R. [Imaging for urinary incontinence]. Urologe A 2015; 54:963-71. [PMID: 26162272 DOI: 10.1007/s00120-015-3872-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Ultrasonography and functional cine magnetic resonance imaging (MRI) are noninvasive and x-ray free tools, which are currently widely used in clinical diagnostics and scientific research of male and female urinary incontinence. The increasing use and improving techniques of modern imaging tools are closely linked to rapid development of minimally invasive surgery in patients with urinary incontinence and insights gained in continence mechanisms. METHODS Whereas ultrasonography is a cost-efficient and readily available diagnostic tool for a routine use, the more expensive functional MRI, as a tool with more precise visualization of functional interactions and spatial representation of anatomical structures of the pelvic floor, is suitable for complex diagnostic purposes and scientific research. Both tools are already well established for evaluations of the female pelvic floor. For evaluation of the male pelvic floor, and in particular postprostatectomy incontinence, perineal ultrasonography and functional cine MRI are becoming increasingly evident. CONCLUSION Further development of both imaging tools will contribute to new insights into the continence mechanism and improve the techniques of radical prostatectomy and minimally invasive surgery of male and female urinary incontinence in the future.
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Affiliation(s)
- I Soljanik
- Neuro-Urologie, Klinik für Paraplegiologie, Department für Orthopädie, Unfallchirurgie und Paraplegiologie, Universität Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland,
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34
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A review of functional pelvic floor imaging modalities and their effectiveness. Clin Imaging 2015; 39:559-65. [DOI: 10.1016/j.clinimag.2015.02.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 02/06/2015] [Accepted: 02/23/2015] [Indexed: 02/06/2023]
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35
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Onal S, Lai-Yuen SK, Bao P, Weitzenfeld A, Hart S. MRI-based segmentation of pubic bone for evaluation of pelvic organ prolapse. IEEE J Biomed Health Inform 2015; 18:1370-8. [PMID: 25014940 DOI: 10.1109/jbhi.2014.2302437] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Pelvic organ prolapse (POP) is a major women's health problem. Its diagnosis through magnetic resonance imaging (MRI) has become popular due to current inaccuracies of clinical examination. The diagnosis of POP on MRI consists of identifying reference points on pelvic bone structures for measurement and evaluation. However, it is currently performed manually, making it a time-consuming and subjective procedure. We present a new segmentation approach for automating pelvic bone point identification on MRI. It consists of a multistage mechanism based on texture-based block classification, leak detection, and prior shape information. Texture-based block classification and clustering analysis using K-means algorithm are integrated to generate the initial bone segmentation and to identify leak areas. Prior shape information is incorporated to obtain the final bone segmentation. Then, the reference points are identified using morphological skeleton operation. Results demonstrate that the proposed method achieves higher bone segmentation accuracy compared to other segmentation methods. The proposed method can also automatically identify reference points faster and with more consistency compared with the manually identified point process by experts. This research aims to enable faster and consistent pelvic measurements on MRI to facilitate and improve the diagnosis of female POP.
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Pontbriand-Drolet S, Tang A, Madill SJ, Tannenbaum C, Lemieux MC, Corcos J, Dumoulin C. Differences in pelvic floor morphology between continent, stress urinary incontinent, and mixed urinary incontinent elderly women: An MRI study. Neurourol Urodyn 2015; 35:515-21. [PMID: 25727524 DOI: 10.1002/nau.22743] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 01/12/2015] [Indexed: 12/24/2022]
Abstract
AIMS To compare magnetic resonance imaging (MRI) of the pelvic floor musculature (PFM), bladder neck and urethral sphincter morphology under three conditions (rest, PFM maximal voluntary contraction (MVC), and straining) in older women with symptoms of stress (SUI) or mixed urinary incontinence (MUI) or without incontinence. METHODS This 2008-2012 exploratory observational cohort study was conducted with community-dwelling women aged 60 and over. Sixty six women (22 per group), mean age of 67.7 ± 5.2 years, participated in the study. A 3 T MRI examination was conducted under three conditions: rest, PFM MVC, and straining. ANOVA or Kruskal-Wallis tests (data not normally distributed) were conducted, with Bonferroni correction, to compare anatomical measurements between groups. RESULTS Women with MUI symptoms had a lower PFM resting position (M-Line P = 0.010 and PC/H-line angle P = 0.026) and lower pelvic organ support (urethrovesical junction height P = 0.013) than both continent and SUI women. Women with SUI symptoms were more likely to exhibit bladder neck funneling and a larger posterior urethrovesical angle at rest than both continent and MUI women (P = 0.026 and P = 0.008, respectively). There were no significant differences between groups on PFM MVC or straining. CONCLUSIONS Women with SUI and MUI symptoms present different morphological defects at rest. These observations emphasize the need to tailor UI interventions to specific pelvic floor defects and UI type in older women. PATIENT SUMMARY Older women with UI demonstrate different problems with their pelvic organ support structures depending on the type of UI. These new findings should be taken into consideration for future research into developing new treatment strategies for UI in older women. Neurourol. Urodynam. 35:515-521, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Stéphanie Pontbriand-Drolet
- Faculty of Medicine, University of Montreal, Montreal, Canada.,Research Centre, Institut Universitaire de Gériatrie de Montréal, Montreal, Canada
| | - An Tang
- Faculty of Medicine, University of Montreal, Montreal, Canada.,Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada.,Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Stephanie J Madill
- School of Physical Therapy, University of Saskatchewan, Saskatchewan, Canada
| | - Cara Tannenbaum
- Faculty of Medicine, University of Montreal, Montreal, Canada.,Research Centre, Institut Universitaire de Gériatrie de Montréal, Montreal, Canada
| | - Marie-Claude Lemieux
- Faculty of Medicine, University of Montreal, Montreal, Canada.,Department of Obstetrics & Gynecology, Maisonneuve Rosemont Hospital, Montreal, Canada
| | - Jacques Corcos
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Canada
| | - Chantale Dumoulin
- Faculty of Medicine, University of Montreal, Montreal, Canada.,Research Centre, Institut Universitaire de Gériatrie de Montréal, Montreal, Canada
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Onal S, Lai-Yuen S, Bao P, Weitzenfeld A, Hogue D, Hart S. Quantitative assessment of new MRI-based measurements to differentiate low and high stages of pelvic organ prolapse using support vector machines. Int Urogynecol J 2014; 26:707-13. [PMID: 25429825 DOI: 10.1007/s00192-014-2582-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 11/10/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective of this study was to quantitatively assess the ability of new MRI-based measurements to differentiate low and high stages of pelvic organ prolapse. New measurements representing pelvic structural characteristics are proposed and analyzed using support vector machines (SVM). METHODS This retrospective study used data from 207 women with different types and stages of prolapse. Their demographic information, clinical history, and dynamic MRI data were obtained from the database. New MRI measurements were extracted and analyzed based on these reference lines: pubococcygeal line (PCL), mid-pubic line (MPL), true conjugate line (TCL), obstetric conjugate line (OCL), and diagonal conjugate line (DCL). A classification model using SVM was designed to assess the impact of the features (variables) in classifying prolapse into low or high stage. RESULTS The classification model using SVM can accurately identified anterior prolapse with very high accuracy (>0.90), and apical and posterior prolapse with good accuracy (0.80 - 0.90). Two newly proposed MRI-based features were found to be significant in the identification of anterior and posterior prolapse: the angle between TCL and MPL for anterior prolapse, and the angle between DCL and PCL for posterior prolapse. The overall accuracy of posterior prolapse identification increased from 47% to 80% when the newly proposed MRI-based features were taken into consideration. CONCLUSIONS The proposed MRI-based measurements are effective in differentiating low and high stages of pelvic organ prolapse, particularly for posterior prolapse.
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Affiliation(s)
- S Onal
- Department of Mechanical and Industrial Engineering, Southern Illinois University-Edwardsville, Edwardsville, IL, USA
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García del Salto L, de Miguel Criado J, Aguilera del Hoyo LF, Gutiérrez Velasco L, Fraga Rivas P, Manzano Paradela M, Díez Pérez de las Vacas MI, Marco Sanz AG, Fraile Moreno E. MR Imaging–based Assessment of the Female Pelvic Floor. Radiographics 2014; 34:1417-39. [DOI: 10.1148/rg.345140137] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Azab IA, Nasef MA, Ibrahim AM. Dynamic magnetic resonance imaging; reliability of assessment and correlation with clinical findings of pelvic organ prolapse. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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40
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Abstract
Physical examination alone is often inadequate for evaluation of pelvic floor dysfunction. Magnetic resonance imaging (MRI) is a robust modality that can provide high-quality anatomic and functional evaluation of the pelvic floor. Although lack of standardized technique and radiologist inexperience may be relative deterrents in universal acceptance of pelvic floor MRI, the role of MRI is increasing as it is technically feasible on most magnets and offers some advantages over the traditional fluoroscopic defecography. This review focuses on the technical and interpretational aspects of anatomic and functional pelvic floor MRI.
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Affiliation(s)
- Gaurav Khatri
- From the Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
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41
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Alt CD, Brocker KA, Lenz F, Sohn C, Kauczor HU, Hallscheidt P. MRI findings before and after prolapse surgery. Acta Radiol 2014; 55:495-504. [PMID: 23939382 DOI: 10.1177/0284185113497201] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Therapeutical outcome after prolapse surgery is evaluated using a standardized grading system based on maximum prolapse extent, which might not provide the full picture of the patient's subjective outcome. We therefore applied an evaluation method, which is detached from a grading system. PURPOSE To evaluate the impact of pelvic organ mobility in dynamic magnetic resonance imaging (MRI) before and after mesh-repair surgery in patients with symptomatic pelvic organ prolapse. MATERIAL AND METHODS To obtain measurements, we performed parasagittal T2-weighted turbo spin echo sequence at rest (TR, 3460 ms; TE, 85 ms; matrix, 512; slice thickness [ST], 5 mm), parasagittal T2-weighted true fast imaging with steady-state precession (TrueFISP) single-shot sequence during straining (TR, 397.4 ms; TE, 1.5 ms; matrix, 256; ST, 8 mm), and parasagittal T2-weighted TrueFISP sequence at maximum strain (TR, 4.3 ms; TE, 2.15 ms; matrix, 256; ST, 5 mm) at 1.5 T MRI. Pelvic organ prolapse (anatomical landmarks: bladder, cervix, pouch, rectum) was measured perpendicularly with reference to the pubococcygeal and the midpubic line. Pelvic organ mobility was defined as the difference between the measured distance at rest and at maximum strain for each anatomical landmark. All patients underwent mesh-repair procedure. Eighty patients could be included in this short-term follow-up study. Due to the physical diagnosis of pelvic organ prolapse, 51 underwent anterior mesh repair, 16 underwent posterior mesh repair, and 13 underwent total mesh repair. Surgery was performed by one surgeon, using mesh implants from several manufacturers. RESULTS Median values of maximum organ prolapse for bladder, cervix, pouch, and rectum preoperatively were 2.54 cm, 0.33 cm, 2.47 cm, and 0.32 cm, respectively, and 12 weeks postoperatively 0.87 cm, -1.79 cm, 1.49 cm, and 0.49 cm, respectively. Highly significant improvement (P < 0.001) of pelvic organ mobility was observed in the treated compartment at 4- and 12-week follow-up. Physical evaluation 12 weeks after mesh-repair showed an asymptomatic POP-Q stage I, if any. CONCLUSION Dynamic MRI is useful in visualizing the maximum extent of pelvic organ prolapse, as the evaluation of pelvic organ mobility documents the intraindividual therapeutic outcome detached from a grading system based on maximal prolapse values.
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Affiliation(s)
- Céline D Alt
- Department of Diagnostic and Interventional Radiology, University of Heidelberg Medical School, Heidelberg, Germany
| | - Kerstin A Brocker
- Department of Obstetrics and Gynecology, University of Heidelberg Medical School, Heidelberg, Germany
| | - Florian Lenz
- Department of Gynecology and Obstetrics, Marienhospital, Neustadt / Weinstrasse, Germany
| | - Christof Sohn
- Department of Obstetrics and Gynecology, University of Heidelberg Medical School, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University of Heidelberg Medical School, Heidelberg, Germany
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Prevalence of pelvic organ prolapse detected at dynamic MRI in women without history of pelvic floor dysfunction: Comparison of two reference lines. Clin Radiol 2014; 69:e71-7. [DOI: 10.1016/j.crad.2013.09.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Revised: 09/09/2013] [Accepted: 09/20/2013] [Indexed: 11/23/2022]
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Dynamic magnetic resonance imaging before and 6 months after laparoscopic sacrocolpopexy. Int Urogynecol J 2013; 25:507-15. [PMID: 24146073 DOI: 10.1007/s00192-013-2254-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 10/01/2013] [Indexed: 12/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective of this study was to correlate dynamic magnetic resonance imaging (MRI) with Pelvic Organ Prolapse Quantification (POP-Q) measurements and pelvic floor symptoms in order to determine the value of dynamic MRI for evaluating vaginal vault prolapse both before and 6 months after laparoscopic sacrocolpopexy. METHODS This was a prospective, single-center cohort study in 43 patients who underwent a modified laparoscopic sacrocolpopexy/hysteropexy operation using bone-anchor fixation and synthetic mesh. The study included dynamic MRI, POP-Q staging, and validated questionnaires before and 6 months after laparoscopic sacrocolpopexy. To assess MRI data, the pubococcygeal reference line and specifically defined anatomical landmarks for the separate compartments were used. Differences between pre- and postoperative measurements were evaluated with the Wilcoxon signed-rank test, and correlations at the 0.05 level were considered to be significant (Pearson correlation, two tailed). RESULTS At 6 months, a statistically significant improvement was seen in POP-Q staging for all compartments. Dynamic MRI measurements only revealed a significant improvement after surgery for the apical compartment. The correlation between (changes in) MRI measurements, POP-Q measurements, and validated questionnaires was poor. CONCLUSIONS The value of dynamic MRI for evaluating and documenting changes in vaginal vault support and position after laparoscopic sacrocolpopexy is limited due to the poor correlation with both POP-Q staging and pelvic floor symptoms.
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Rizk DEE, Tunn R. Standardization of dynamic magnetic resonance imaging measurements of pelvic organ prolapse: can the PICS line help? Int Urogynecol J 2013; 24:1419-20. [PMID: 23712580 DOI: 10.1007/s00192-013-2130-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 05/09/2013] [Indexed: 11/25/2022]
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On pelvic reference lines and the MR evaluation of genital prolapse: a proposal for standardization using the Pelvic Inclination Correction System. Int Urogynecol J 2013; 24:1421-8. [PMID: 23640002 DOI: 10.1007/s00192-013-2100-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 03/20/2013] [Indexed: 10/26/2022]
Abstract
Five midsagittal pelvic reference lines have been employed to quantify prolapse using MRI. However, the lack of standardization makes study results difficult to compare. Using MRI scans from 149 women, we demonstrate how use of existing reference lines can systematically affect measurements in three distinct ways: in oblique line systems, distances measured to the reference line vary with antero-posterior location; soft issue-based reference lines can underestimate organ movement relative to the pelvic bones; and systems defined relative to the MR scanner are affected by intra- and interindividual differences in the pelvic inclination angle at rest and strain. Thus, we propose a standardized approach called the Pelvic Inclination Correction System (PICS). Based on bony structures and the body axis, the PICS system corrects for variation in pelvic inclination, at rest of straining, and allows for the standardized measurement of organ displacement in the direction of prolapse.
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Lakeman MME, Zijta FM, Peringa J, Nederveen AJ, Stoker J, Roovers JPWR. Dynamic magnetic resonance imaging to quantify pelvic organ prolapse: reliability of assessment and correlation with clinical findings and pelvic floor symptoms. Int Urogynecol J 2012; 23:1547-54. [PMID: 22531955 PMCID: PMC3484313 DOI: 10.1007/s00192-012-1772-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 03/20/2012] [Indexed: 11/29/2022]
Abstract
Introduction and hypothesis The aim of this study was to assess the interobserver agreement of magnetic resonance imaging (MRI)-based staging of pelvic organ prolapse (POP) and to quantify associations between MRI-based POP staging, findings at pelvic examination, and pelvic floor symptoms. Methods This was a cross-sectional study of ten symptomatic POP patients, ten symptomatic patients without POP, and ten nulliparous asymptomatic women. Three different observers performed MRI-based POP staging using the pubococcygeal line (PCL), midpubic line (MPL), perineal line, and H line as references. Results The interobserver agreement of MRI-based staging of the anterior and middle compartment was good to excellent. In symptomatic women without prolapse, MRI-based and pelvic-examination-based POP staging were poorly correlated. In none of the women were MRI-based POP Quantification (POP-Q) staging and pelvic floor symptoms strongly associated. Conclusion The interobserver agreement of MRI-based POP staging is excellent, but the added clinical value of such staging is questionable due to poor association with clinical findings and pelvic floor symptoms.
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Affiliation(s)
- Mariëlle M E Lakeman
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Room H4-205, PO Box 22700, 1105 DE, Amsterdam, The Netherlands.
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Grimes CL, Lukacz ES. Posterior vaginal compartment prolapse and defecatory dysfunction: are they related? Int Urogynecol J 2012; 23:537-51. [PMID: 22222672 DOI: 10.1007/s00192-011-1629-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 12/06/2011] [Indexed: 02/07/2023]
Abstract
While posterior vaginal compartment prolapse and defecatory dysfunction are highly prevalent conditions in women with pelvic floor disorders, the relationship between anatomy and symptoms, specifically obstructed defecation, is incompletely understood. This review discusses the anatomy of the posterior vaginal compartment and definitions of defecatory dysfunction and obstructed defecation. A clinically useful classification system for defecatory dysfunction is highlighted. Available tools for the measurement of symptoms, physical findings, and imaging in women with posterior compartment prolapse are discussed. Based on a critical review of the literature, we investigate and summarize whether posterior compartment anatomy correlates with function. Definitions of obstructed defecation and significant posterior compartment prolapse are proposed for future exploration.
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Affiliation(s)
- Cara L Grimes
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Reproductive Medicine, University of California-San Diego, La Jolla, CA, USA.
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Cui GC, Li HS, Wang XF. Dynamic magnetic resonance imaging of pelvic organ prolapse: recent research progress. Shijie Huaren Xiaohua Zazhi 2011; 19:2515-2520. [DOI: 10.11569/wcjd.v19.i24.2515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Pelvic organ prolapse (POP) refers to herniation of pelvic organs caused by the weak pelvic floor support structures. Magnetic resonance imaging (MRI) is a non-radioactive, non-invasive, fast, comprehensive, high-resolution imaging technique that has strong soft tissue contrast and can clearly show the changes of muscles and fascia structures of pelvic floor to the resting and dynamic position. It can help understand the state of pelvic organizations and provide objective imaging data for the clinical diagnosis. Dynamic MRI is commonly used for the diagnosis of bladder prolapse and swelling, uterine and vaginal prolapse, rectal prolapse and enterocele. Currently, there are no unified diagnostic criteria for POP in China. Although the US HMO system is frequently used for assessing the degree of POP, it needs to be further explored whether this system is fit for the Chinese population. In short, dynamic MRI permits a comprehensive evaluation of pelvic organ prolapse. It is an important way to study the living anatomy, shape and movement of pelvic floor. In addition to clinical evaluations, dynamic MRI (especially dynamic MRI defecography) plays a role in guiding the interdisciplinary treatment of pelvic floor dysfunction.
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Madill S, Tang A, Pontbriand-Drolet S, Dumoulin C. Comparison of two methods for measuring the pubococcygeal line from sagittal-plane magnetic resonance imaging. Neurourol Urodyn 2011; 30:1613-9. [DOI: 10.1002/nau.21079] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 01/27/2011] [Indexed: 11/12/2022]
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