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Kämpfer C, Pieper CC. [Dynamic magnetic resonance imaging of the pelvic floor: Technical aspects]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:793-798. [PMID: 37831100 DOI: 10.1007/s00117-023-01212-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Dynamic magnetic resonance imaging (MRI) of the pelvic floor plays a key role in imaging complex pelvic floor dysfunction. High-quality examination is crucial for diagnostic benefit but can be technically challenging. OBJECTIVES The most important technical aspects (patient selection, patient preparation, MRI technology, MRI scan protocol, success control) for obtaining a state-of-the-art dynamic MRI of the pelvic floor are summarized. MATERIALS AND METHODS Review of the scientific literature on dynamic pelvic MR imaging with special consideration of the joint recommendations provided by the expert panels of European Society of Urogenital Radiology/European Society of Gastrointestinal and Abdominal Radiology (ESUR/ESGAR) in 2016 and Society of Abdominal Radiology (SAR) in 2019. RESULTS Examination with at least 1.5 T and a surface coil after rectal instillation of ultrasound gel is clinical standard. Dynamic MRI in a closed magnet with the patient in supine position is the most widespread technique. No clinically significant pathologies of the pelvic floor are missed compared to the sitting position in an open magnet. The minimum scan protocol should encompass static, high-resolution T2-imaging (i.e., T2-TSE) in three planes and dynamic sequences with high temporal resolution in sagittal (and possibly axial) plane (i.e., steady-state or balanced steady-state free precession) during squeezing, straining and evacuation. Detailed patient instruction and practicing prior to the scan improve patients' compliance and hence diagnostic quality. CONCLUSIONS A technically flawless dynamic MRI of the pelvic floor according to these standards can provide information missed by other imaging modalities and hence alter therapeutic strategies.
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Affiliation(s)
- C Kämpfer
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland.
| | - C C Pieper
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
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Consensus Definitions and Interpretation Templates for Magnetic Resonance Imaging of Defecatory Pelvic Floor Disorders: Proceedings of the Consensus Meeting of the Pelvic Floor Disorders Consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the International Continence Society, the American Urogynecologic Society, the International Urogynecological Association, and the Society of Gynecologic Surgeons. Female Pelvic Med Reconstr Surg 2021; 27:e645-e656. [PMID: 34506350 DOI: 10.1097/spv.0000000000001111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gurland BH, Khatri G, Ram R, Hull TL, Kocjancic E, Quiroz LH, El Sayed RF, Jambhekar KR, Chernyak V, Mohan Paspulati R, Sheth VR, Steiner AM, Kamath A, Shobeiri SA, Weinstein MM, Bordeianou L. Consensus Definitions and Interpretation Templates for Magnetic Resonance Imaging of Defecatory Pelvic Floor Disorders: Proceedings of the Consensus Meeting of the Pelvic Floor Disorders Consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the International Continence Society, the American Urogynecologic Society, the International Urogynecological Association, and the Society of Gynecologic Surgeons. Dis Colon Rectum 2021; 64:1184-1197. [PMID: 34516442 DOI: 10.1097/dcr.0000000000002155] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Brooke H Gurland
- Division of Colorectal Surgery, Stanford University, Palo Alto, California
| | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Roopa Ram
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Tracy L Hull
- Department of Colorectal Surgery, Cleveland Clinic Hospitals, Cleveland, Ohio
| | - Ervin Kocjancic
- Department of Urology, College of Medicine University of Illinois, Chicago, Illinois
| | - Lieschen H Quiroz
- Department of Obstetrics & Gynecology, University of Oklahoma, Oklahoma City, Oklahoma
| | - Rania F El Sayed
- Department of Radiology, Cairo University Pelvic Floor Centre of Excellency and Research Lab, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Kedar R Jambhekar
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Victoria Chernyak
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, The Bronx, New York
| | - Raj Mohan Paspulati
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Vipul R Sheth
- Department of Radiology, Stanford University, Palo Alto, California
| | - Ari M Steiner
- Department of Radiology, Mount Sinai South Nassau Hospital, Oceanside, New York
| | - Amita Kamath
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - S Abbas Shobeiri
- Department of Obstetrics & Gynecology, University of Virginia, INOVA Women's Hospital, Falls Church, Virginia
| | - Milena M Weinstein
- Department of Obstetrics & Gynecology, Massachusetts General Hospital Pelvic Floor Disorders Center, Harvard Medical School, Boston, Massachusetts
| | - Liliana Bordeianou
- Department of Gastrointestinal Surgery, Massachusetts General Hospital Pelvic Floor Disorders Center, Harvard Medical School, Boston, Massachusetts
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Gurland BH, Khatri G, Ram R, Hull TL, Kocjancic E, Quiroz LH, El Sayed RF, Jambhekar KR, Chernyak V, Paspulati RM, Sheth VR, Steiner AM, Kamath A, Shobeiri SA, Weinstein MM, Bordeianou L. Consensus definitions and interpretation templates for magnetic resonance imaging of Defecatory pelvic floor disorders : Proceedings of the consensus meeting of the pelvic floor disorders consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the international continence society, the American Urogynecologic Society, the international Urogynecological association, and the Society of Gynecologic Surgeons. Int Urogynecol J 2021; 32:2561-2574. [PMID: 34505921 DOI: 10.1007/s00192-021-04955-z] [citation(s)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Affiliation(s)
- Brooke H Gurland
- Division of Colorectal Surgery, Stanford University, Palo Alto, CA, USA
| | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Roopa Ram
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Tracy L Hull
- Department of Colorectal Surgery, Cleveland Clinic Hospitals, Cleveland, OH, USA
| | - Ervin Kocjancic
- Department of Urology, College of Medicine University of Illinois, Chicago, IL, USA
| | - Lieschen H Quiroz
- Department of Obstetrics & Gynecology, University of Oklahoma, Oklahoma City, Ok, USA
| | - Rania F El Sayed
- Department of Radiology, Cairo University Pelvic Floor Centre of Excellency and Research Lab, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Kedar R Jambhekar
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Victoria Chernyak
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, The Bronx, NY, USA
| | - Raj Mohan Paspulati
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Vipul R Sheth
- Department of Radiology, Stanford University, Palo Alto, CA, USA
| | - Ari M Steiner
- Department of Radiology, Mount Sinai South Nassau Hospital, Oceanside, NY, USA
| | - Amita Kamath
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - S Abbas Shobeiri
- Department of Obstetrics & Gynecology, University of Virginia, INOVA Women's Hospital, Falls Church, VA, USA
| | - Milena M Weinstein
- Department of Obstetrics & Gynecology, Massachusetts General Hospital Pelvic Floor Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Liliana Bordeianou
- Department of Gastrointestinal Surgery, Massachusetts General Hospital Pelvic Floor Disorders Center, Harvard Medical School, Boston, MA, USA.
- Massachusetts General Hospital Surgery, 55 Fruit St, GRB 425, Boston, MA, 02114, USA.
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Consensus Definitions and Interpretation Templates for Magnetic Resonance Imaging of Defecatory Pelvic Floor Disorders: Proceedings of the Consensus Meeting of the Pelvic Floor Disorders Consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the International Continence Society, the American Urogynecologic Society, the International Urogynecological Association, and the Society of Gynecologic Surgeons. AJR Am J Roentgenol 2021; 217:800-812. [PMID: 34505543 DOI: 10.2214/ajr.21.26488] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The Pelvic Floor Disorders Consortium (PFDC) is a multidisciplinary organization of colorectal surgeons, urogynecologists, urologists, gynecologists, gastroenterologists, radiologists, physiotherapists, and other advanced care practitioners. Specialists from these fields are all dedicated to the diagnosis and management of patients with pelvic floor conditions, but they approach, evaluate, and treat such patients with their own unique perspectives given the differences in their respective training. The PFDC was formed to bridge gaps and enable collaboration between these specialties. The goal of the PFDC is to develop and evaluate educational programs, create clinical guidelines and algorithms, and promote high quality of care in this unique patient population. The recommendations included in this article represent the work of the PFDC Working Group on Magnetic Resonance Imaging of Pelvic Floor Disorders (members listed alphabetically in Table 1). The objective was to generate inclusive, rather than prescriptive, guidance for all practitioners, irrespective of discipline, involved in the evaluation and treatment of patients with pelvic floor disorders.
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Gurland BH, Khatri G, Ram R, Hull TL, Kocjancic E, Quiroz LH, El Sayed RF, Jambhekar KR, Chernyak V, Paspulati RM, Sheth VR, Steiner AM, Kamath A, Shobeiri SA, Weinstein MM, Bordeianou L. Consensus definitions and interpretation templates for magnetic resonance imaging of Defecatory pelvic floor disorders : Proceedings of the consensus meeting of the pelvic floor disorders consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the international continence society, the American Urogynecologic Society, the international Urogynecological association, and the Society of Gynecologic Surgeons. Int Urogynecol J 2021; 32:2561-2574. [PMID: 34505921 DOI: 10.1007/s00192-021-04955-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Brooke H Gurland
- Division of Colorectal Surgery, Stanford University, Palo Alto, CA, USA
| | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Roopa Ram
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Tracy L Hull
- Department of Colorectal Surgery, Cleveland Clinic Hospitals, Cleveland, OH, USA
| | - Ervin Kocjancic
- Department of Urology, College of Medicine University of Illinois, Chicago, IL, USA
| | - Lieschen H Quiroz
- Department of Obstetrics & Gynecology, University of Oklahoma, Oklahoma City, Ok, USA
| | - Rania F El Sayed
- Department of Radiology, Cairo University Pelvic Floor Centre of Excellency and Research Lab, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Kedar R Jambhekar
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Victoria Chernyak
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, The Bronx, NY, USA
| | - Raj Mohan Paspulati
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Vipul R Sheth
- Department of Radiology, Stanford University, Palo Alto, CA, USA
| | - Ari M Steiner
- Department of Radiology, Mount Sinai South Nassau Hospital, Oceanside, NY, USA
| | - Amita Kamath
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - S Abbas Shobeiri
- Department of Obstetrics & Gynecology, University of Virginia, INOVA Women's Hospital, Falls Church, VA, USA
| | - Milena M Weinstein
- Department of Obstetrics & Gynecology, Massachusetts General Hospital Pelvic Floor Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Liliana Bordeianou
- Department of Gastrointestinal Surgery, Massachusetts General Hospital Pelvic Floor Disorders Center, Harvard Medical School, Boston, MA, USA. .,Massachusetts General Hospital Surgery, 55 Fruit St, GRB 425, Boston, MA, 02114, USA.
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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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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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9
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Lalwani N, Khatri G, El Sayed RF, Ram R, Jambhekar K, Chernyak V, Kamath A, Lewis S, Flusberg M, Scholz F, Arif-Tiwari H, Palmer SL, Lockhart ME, Fielding JR. MR defecography technique: recommendations of the society of abdominal radiology's disease-focused panel on pelvic floor imaging. Abdom Radiol (NY) 2021; 46:1351-1361. [PMID: 31385010 DOI: 10.1007/s00261-019-02160-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE To develop recommendations for magnetic resonance (MR) defecography technique based on consensus of expert radiologists on the disease-focused panel of the Society of Abdominal Radiology (SAR). METHODS An extensive questionnaire was sent to a group of 20 experts from the disease-focused panel of the SAR. The questionnaire encompassed details of technique and MRI protocol used for evaluating pelvic floor disorders. 75% agreement on questionnaire responses was defined as consensus. RESULTS The expert panel reached consensus for 70% of the items and provided the basis of these recommendations for MR defecography technique. There was unanimous agreement that patients should receive coaching and explanation of commands used during MR defecography, the rectum should be distended with contrast agent, and that sagittal T2-weighted images should include the entire pelvis within the field of view. The panel also agreed unanimously that IV contrast should not be used for MR defecography. Additional areas of consensus ranged in agreement from 75 to 92%. CONCLUSION We provide a set of consensus recommendations for MR defecography technique based on a survey of expert radiologists in the SAR pelvic floor dysfunction disease-focused panel. These recommendations can be used to develop a standardized imaging protocol.
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Affiliation(s)
- Neeraj Lalwani
- Wake Forest University Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | - Gaurav Khatri
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Roopa Ram
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kedar Jambhekar
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Victoria Chernyak
- Albert Einstein College of Medicine, Montefiore Medical Center, The Bronx, NY, USA
| | - Amita Kamath
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sara Lewis
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Milana Flusberg
- Department of Radiology, Westchester Medical Center, Valhalla, NY, USA
| | | | | | - Suzanne L Palmer
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mark E Lockhart
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Julia R Fielding
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
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Puthanmadhom Narayanan S, Sharma M, Fletcher JG, Karwoski RA, Holmes DR, Bharucha AE. Comparison of changes in rectal area and volume during MR evacuation proctography in healthy and constipated adults. Neurogastroenterol Motil 2019; 31:e13608. [PMID: 31025437 PMCID: PMC6559848 DOI: 10.1111/nmo.13608] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/22/2019] [Accepted: 04/09/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND During proctography, rectal emptying is visually estimated by the reduction in rectal area. The correlation between changes in rectal area, which is a surrogate measure of volume, is unclear. Our aims were to compare the change in rectal area and volume during magnetic resonance (MR) proctography and to compare these parameters with rectal balloon expulsion time (BET). METHODS In 49 healthy and 46 constipated participants, we measured BET and rectal area and volume with a software program before and after participants expelled rectal gel during proctography. KEY RESULTS All participants completed both tests; six healthy and 17 constipated patients had a prolonged (>60 seconds) BET. During evacuation, the reduction in rectal area and volume was lower in participants with an abnormal than a normal BET (P < 0.01). The reduction in rectal area and volume were strongly correlated (r = 0.93, P < 0.001) and equivalent for identifying participants with abnormal BET. Among participants with less evacuation, the reduction in rectal area underestimated the reduction in rectal volume. A rectocele larger than 2 cm was observed in eight of 18 (44%) participants in whom the difference between change in volume and area was ˃10% but only 14 of 77 (18%) participants in whom the difference was ≤10% (P = 0.03). CONCLUSIONS Measured with MR proctography, the rectal area is reasonably accurate for quantifying rectal emptying and equivalent to rectal volume for distinguishing between normal and abnormal BET. When evacuation is reduced, the change in rectal area may underestimate the change in rectal volume.
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Affiliation(s)
| | - Mayank Sharma
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | | | - Ronald A Karwoski
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - David R Holmes
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Adil E Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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Engelaere C, Poncelet E, Durot C, Dohan A, Rousset P, Hoeffel C. Pelvic MRI: Is Endovaginal or Rectal Filling Needed? Korean J Radiol 2018; 19:397-409. [PMID: 29713217 PMCID: PMC5904466 DOI: 10.3348/kjr.2018.19.3.397] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/07/2017] [Indexed: 01/28/2023] Open
Abstract
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.
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Affiliation(s)
- Constance Engelaere
- Department of Radiology, Centre Hospitalo-Universitaire de Reims, Reims 51092, France
| | - Edouard Poncelet
- Department of Radiology, Centre Hospitalier de Valenciennes, Valenciennes 59300, France
| | - Carole Durot
- Department of Radiology, Centre Hospitalo-Universitaire de Reims, Reims 51092, France
| | - Anthony Dohan
- Department of Abdominal Imaging, Hôpital Lariboisière-APHP, Paris 75010, France
| | - Pascal Rousset
- Department of Radiology, Hospices civils de Lyon, Centre hospitalier Lyon-Sud, Université Claude-Bernard Lyon 1, Pierre-Bénite 69495, France
| | - Christine Hoeffel
- Department of Radiology, Centre Hospitalo-Universitaire de Reims, Reims 51092, France
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12
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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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13
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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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14
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Gupta MK, Khatri G, Bailey A, Pinho DF, Costa D, Pedrosa I. Endoluminal contrast for abdomen and pelvis magnetic resonance imaging. Abdom Radiol (NY) 2016; 41:1378-98. [PMID: 26907710 DOI: 10.1007/s00261-016-0668-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Magnetic resonance (MR) imaging of the abdomen and pelvis can be limited for assessment of different conditions when imaging inadequately distended hollow organs. Endoluminal contrast agents may provide improved anatomic definition and detection of subtle pathology in such scenarios. The available routes of administration for endoluminal contrast agents include oral, endorectal, endovaginal, intravesicular, and through non-physiologic accesses. Appropriate use of endoluminal contrast agents requires a thorough understanding of the clinical indications, available contrast agents, patient preparation, and interaction of the contrast agent with the desired MR imaging protocol. For example, biphasic oral enteric contrast agents are preferred in MR enterography as their signal properties on T1- and T2-weighted imaging allow for evaluation of both intraluminal and bowel wall pathology. In specific situations such as with MR enterography, MR defecography, and accurate local staging of certain pelvic tumors, the use of an endoluminal contrast agent is imperative in providing adequate diagnostic imaging. In other clinical scenarios, the use of an endoluminal contrast agent may serve as an indispensable problem-solving tool.
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Affiliation(s)
- Mohit K Gupta
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9085, USA
| | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9085, USA
| | - April Bailey
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9085, USA
| | - Daniella F Pinho
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9085, USA
| | - Daniel Costa
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9085, USA
| | - Ivan Pedrosa
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9085, USA.
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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15
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Khatri G, Carmel ME, Bailey AA, Foreman MR, Brewington CC, Zimmern PE, Pedrosa I. Postoperative Imaging after Surgical Repair for Pelvic Floor Dysfunction. Radiographics 2016; 36:1233-56. [DOI: 10.1148/rg.2016150215] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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