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

X-ray video defaecography is superior to magnetic resonance defaecography in the imaging of defaecation disorders

AIM

The aim of this work was to study the technical success and diagnostic capability of magnetic resonance defaecography (MRD) compared with video defaecography (VD).

METHOD

Sixty four women with defaecation disorders underwent both MRD and x-ray VD over 1 year. The assessment by two radiologists in consensus was retrospective and blinded. The technical success of straining and evacuation was evaluated subjectively. The presence of enterocele, intussusception, rectocele and dyssynergic defaecation was analysed according to established criteria, with VD as the standard of reference.

RESULTS

It was found that 62/64 (96.9%) VD studies were technically fully diagnostic compared with 29/64 (45.3%) for MRD. The number of partially diagnostic studies was 1/64 (1.6%) for VD versus 21/64 (32.8%) for MRD, with 1/64 (1.6%) (VD) and 14/64 (21.9%) (MRD) being nondiagnostic. Thirty enteroceles were observed by VD compared with seven in MRD with moderate agreement (κ = 0.41). Altogether 53 intussusceptions were observed by VD compared with 27 by MRD with poor agreement (κ = -0.10 and κ = 0.02 in recto-rectal and recto-anal intussusception, respectively). Moderate agreement (κ = 0.47) was observed in diagnosing rectocele, with 47 cases by VD and 29 by MRD. Dyssynergic defaecation was observed in three patients by VD and in 11 patients by MRD, with slight agreement (κ = 0.14).

CONCLUSION

The technical success and diagnostic capabilities of VD are better than those of MRD. VD remains the method of choice in the imaging of defaecation disorders.

Mini-review: Modern Concept of Pelvic Organ Prolapse

Symptomatic pelvic organ prolapse (POP) has been increasing in recent years for both developed and developing countries. By 2050, as the adult population grows, the number of women with symptomatic POP will increase by 46%. Due to the increasing number of complications after surgery among women with POP, the current understanding of treatment has become extremely important for researchers and practitioners. There are many novel conservative and surgical treatment approaches under investigation. However, some primary surgical treatments show an approximate 30–50% risk of repeated pelvic floor reconstruction. Therefore, the review aims to summarize several conservative treatment options and identify critical areas of need for future research.

Dynamic magnetic resonance imaging evaluation before and after operation for pelvic organ prolapse

PURPOSE

This study aimed to explore the value of dynamic magnetic resonance imaging (MRI) before and after operation for pelvic organ prolapse (POP).

METHODS

Twenty-nine patients with POP (POP group) before and one month after surgery and 12 healthy women (control group) underwent static and dynamic MRI at rest and during straining (Valsalva maneuver). The preoperative MRI images of the POP and control groups were analyzed, and various measurements were recorded. Differences in measurements were compared between the POP and control groups; similarly, changes in measurements before and after operation were compared.

RESULTS

In the POP group, MRI detected 29 anterior vaginal prolapses, 27 uterine prolapses, 1 rectoceles, and 14 pouch of Douglas hernias. In addition, 27 levator ani muscle defect and 15 pubocervical fascial defect cases were observed. The bladder-pubococcygeal line (B-PCL), uterus-pubococcygeal line (U-PCL), Douglas pouch-pubococcygeal line, the length of the hiatus, the descent of the levator plate, levator hiatus size, levator plate angle, iliococcygeus angle, and urethral inclination angle (UA) were larger in the POP group than in the control group. The pelvic organs' positions returned to normal postoperatively in 9 of 21 cases. The B-PCL, U-PCL, and UA were smaller post-surgery than pre-surgery.

CONCLUSIONS

Static and dynamic MRI can comprehensively evaluate morphological and functional changes of the pelvic floor postoperatively.

Pelvic MRI: Is Endovaginal or Rectal Filling Needed?

Magnetic resonance imaging is the optimal modality for pelvic imaging. It is based on T2-weighted magnetic resonance (MR) sequences allowing uterine and vaginal cavity assessment as well as rectal evaluation. Anatomical depiction of these structures may benefit from distension, and conditions either developing inside the lumen of cavities or coming from the outside may then be better delineated and localized. The need for distension, either rectal or vaginal, and the way to conduct it are matters of debate, depending on indication for which the MR examination is being conducted. In this review, we discuss advantages and potential drawbacks of this technique, based on literature and our experience, in the evaluation of various gynecological and rectal diseases.

Interobserver agreement of multicompartment ultrasound in the assessment of pelvic floor anatomy

OBJECTIVE

To assess the interobserver agreement of pelvic floor anatomical measurements using multicompartment pelvic floor ultrasound.

METHODS

Females were recruited from the urogynaecology/gynaecology clinics between July and October 2009 and underwent multicompartment pelvic floor ultrasonography (PFUS) using two-dimensional (2D) transperineal ultrasound (TPUS), high-frequency 2D/three-dimensional (3D) endovaginal ultrasound (EVUS) using a biplane probe with linear and transverse arrays and a 360° rotational 3D-EVUS. PFUS measurements were independently analysed by two clinicians.

RESULTS

158 females had PFUS assessment. Good-to-excellent interobserver agreement was observed for bladder-symphysis distance at rest and valsalva, urethral thickness, urethral length, urethral volume, levator hiatus area and width, anteroposterior diameter and anorectal angle. Lins Correlation was used to calculate the interobserver agreement and Bland-Altman plots were created to demonstrate the agreement between the researchers. There was also a good-to-excellent agreement between the two clinicians for the assessment of pelvic organ prolapse (POP) in the anterior, middle and posterior compartment.

CONCLUSION

Multicompartment PFUS is a reliable tool in the anatomical assessment of pelvic floor measurements and POP.

ADVANCES IN KNOWLEDGE

We found a good-to-excellent agreement between the two assessors in the assessment of pelvic floor measurements for all three pelvic floor compartments and suggest that multicompartment PFUS could be considered as a systematic integrated approach to assess the pelvic floor.