Dynamic magnetic resonance imaging of the female pelvis: radio-anatomy and pathologic applications. Preliminary results

The role of the MR-fluoroscopy in the diagnosis and staging of the pelvic organ prolapse

INTRODUCTION

The aim of the study is to investigate the efficacy of the magnetic resonance fluoroscopy in the diagnosis and staging of the pelvic prolapse.

MATERIALS AND METHODS

The study consisted of 46 patients who were known to have pelvic prolapses from their vaginal examination. Thirty women who underwent vaginal exam and shown not have pelvic prolapse were selected as a control group. Firstly, pelvic sagittal FSE T2 weighted images of all the women were acquired in 0.3 T open MR equipment than sagittal MR-fluoroscopic images using spoiled gradient echo sequences were obtained during pelvic strain. Physical examination and MR-fluoroscopic findings were compared. The relationship between the stages of prolapse established by both of the methods was evaluated statistically with Pearson's correlation analysis.

RESULTS

Physical examination and MR findings were very concordant in the diagnosis of pelvic prolapse and statistical correlations in the stages of prolapse were established between both of the methods (P<0.01 for anterior and middle comportment, P<0.05 for posterior comportment).

CONCLUSION

We conclude that MR-fluoroscopy is a non-invasive, easily applied, dynamic useful method without contrast agent in the diagnosis and staging of pelvic organ prolapse.

Three-dimensional ultrasound imaging of the pelvic floor: the effect of parturition on paravaginal support structures

OBJECTIVE

It is assumed that support of the female urethra and bladder is maintained by paraurethral and paravaginal fascial structures, with hypermobility resulting from delivery-related trauma. This study used three-dimensional translabial ultrasound to assess these structures and document peripartal changes.

DESIGN

A clinical observational pilot study was performed on 26 nulliparous women recruited in the third trimester of pregnancy. They underwent translabial two- and three-dimensional ultrasound. Twenty-three women were again seen 2-5 months postpartum. The assessor was blinded against two-dimensional ultrasound and delivery data. Vaginal tenting was rated as being present, indeterminate or absent at each of three levels, and was correlated with bladder neck descent (BND) and urethral rotation on Valsalva maneuver.

RESULTS

Tenting was visible at all levels in 21 of 26 women antepartally. In three women tenting was absent on one level; in two cases tenting was rated indeterminate. There was no significant difference in BND between women with visible tenting and those without. The BND range for women with intact tenting was 5.4-41.6 mm. Twenty-one of the 26 women were included in the postpartum analysis. Of these, obvious peripartal changes were documented in five. Loss of tenting did not correlate significantly with changes in BND.

CONCLUSIONS

Most nulliparous women showed evidence of intact paravaginal support structures. Tenting occurred in women with widely varying BND, implying that excess bladder neck mobility may be due to increased fascial compliance. Postnatally, fascial disruption was suspected in a minority of patients only. In some women delivery-related changes may be due to attenuation rather than disruption of structures.

Recent developments in pelvic organ prolapse

Pelvic organ prolapse is a common worldwide problem. Recent advances in our understanding of its pathophysiology, along with progress made in the evaluation and treatment of pelvic support defects, are discussed. Although the pathophysiology of this condition is still not completely understood, genetic factors and environmental factors are involved. Understanding these factors better will help us to approach treatment of pelvic organ prolapse in a more logical manner. Multiple surgical techniques are available for pelvic relaxation, with a wide range of success rates ranging from 77 to 97% for various procedures. New techniques need to be studied further before being incorporated into routine practice. Better standardization of evaluation methods can help in such clinical studies.