1
|
Cunningham CR, Mehrsheikh AL, Aswani Y, Shetty AS, Itani M, Ballard DH, Khot R, Moshiri M, Picard MM, Northrup BE. Off the wall: incidental paraspinal and pelvic muscle pathology on abdominopelvic imaging. Abdom Radiol (NY) 2024:10.1007/s00261-024-04365-x. [PMID: 38831073 DOI: 10.1007/s00261-024-04365-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 04/27/2024] [Accepted: 04/28/2024] [Indexed: 06/05/2024]
Abstract
As the use of cross-sectional abdominal and pelvic imaging has increased exponentially in the past several decades, incidental musculoskeletal findings have become commonplace. These are often unrelated to the indication for the examination and are frequently referred to as the "radiologist's blind spot" on these studies. The differential diagnosis for abnormalities of the paraspinal and pelvic musculature is, in many cases, quite different from the anterior abdominal wall muscles. Furthermore, due to their relatively deep location, pathology involving the former muscle groups is more likely to be clinically occult, often presenting only incidentally when the patient undergoes cross-sectional imaging. Effective treatment of diseases of these muscles is dependent on adherence to a diverse set of diagnostic and treatment algorithms. The purpose of this review article is to familiarize the radiologist with the unique pathology of these often-overlooked muscles of the abdomen and pelvis.
Collapse
Affiliation(s)
- Christopher R Cunningham
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd., Campus Box 8131, St. Louis, MO, 63110, USA
| | - Amanda L Mehrsheikh
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd., Campus Box 8131, St. Louis, MO, 63110, USA
| | - Yashant Aswani
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Anup S Shetty
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd., Campus Box 8131, St. Louis, MO, 63110, USA
| | - Malak Itani
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd., Campus Box 8131, St. Louis, MO, 63110, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd., Campus Box 8131, St. Louis, MO, 63110, USA
| | - Rachita Khot
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - Mariam Moshiri
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Melissa M Picard
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Benjamin E Northrup
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd., Campus Box 8131, St. Louis, MO, 63110, USA.
| |
Collapse
|
2
|
Matter L, Hebeisen M, Beintner-Skawran S, Reiner CS, Betschart C. MRI characterization of pelvic floor ligaments in nulliparous women: Technique development and morphometry within the 3D pelvic inclination correction system (3D-PICS). Eur J Radiol 2024; 173:111351. [PMID: 38340570 DOI: 10.1016/j.ejrad.2024.111351] [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: 10/02/2023] [Revised: 12/22/2023] [Accepted: 01/25/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE The aim of the MRI-study was to evaluate the visibility of the pelvic floor ligaments and to analyze the ligament morphometry in 3D space. METHODS Twenty-two nulliparous women underwent MRI with a ligament specific protocol. MR datasets were evaluated using the 3D Pelvic Inclination Correction System (3D-PICS). The round ligament (RL), sacrospinous ligament (SSL), sacrotuberous ligament (STL), urogenital diaphragm (UGD) and uterosacral ligament (USL) were analyzed. Qualitative and quantitative analysis was performed. 3D coordinates for origin and insertion points were determined relative to the symphysis; subsequently lengths and angles were calculated. Interrater reliability was calculated to validate the point determination method. RESULTS Moderate to good visibility was reported for the RL, the SSL, the STL and the UGD. Standard deviation of the points analyzed in the different dimensions vary from 1.5 mm to 21.3 mm. Origin and insertion points of the ligaments are found within a mean standard distance of 10.7 mm. The highest variability was seen in insertion points of RL, with a standard distance of 25.4 mm. The interrater reliability was good to very good (range of intraclass correlation coefficients (ICC) from 0.58 to 0.96), except for the UGD ventral points (ICC from 0.27 to 0.55). CONCLUSIONS This in-vivo MRI technique development study offers first exact data describing the pelvic floor ligaments in nulliparous women in 3D-PICS. Visibility, exact 3D coordinates of the origin and insertion points, lengths, angles and interrater reliability assessed for all parameters were evaluated morphometrically.
Collapse
Affiliation(s)
- Lea Matter
- Department of Gynecology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Monika Hebeisen
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
| | - Stephan Beintner-Skawran
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Cäcilia S Reiner
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Cornelia Betschart
- Department of Gynecology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| |
Collapse
|
3
|
Li Y, Gong T, Lin X, Wei X, Cai X, Chen X, Lin L, Wang G. Evaluating changes in the strength of the levator ani muscle after vaginal delivery using T2-parameter mapping. Eur J Radiol 2023; 168:111137. [PMID: 37856940 DOI: 10.1016/j.ejrad.2023.111137] [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: 03/07/2023] [Revised: 10/02/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE To evaluate pelvic floor muscle injury in patients with levator ani muscle (LAM) weakness after vaginal delivery using T2-parameter mapping. MATERIALS AND METHODS 40 parturients (patient group) and 25 nonparturients (healthy control group) were enrolled in the study. The LAM weakness group had a Modified Oxford Grading System (MOGS) grade of less than 3 after vaginal delivery. All participants underwent pelvic magnetic resonance imaging (MRI) scans, including T2 and T2* mapping, on which the main branches of the LAM, the puborectalis and iliococcygeus, were evaluated. The differences in T2 and T2* values in the puborectalis and iliococcygeus between patients with LAM weakness and controls were analyzed using an independent samples t test or a Mann-Whitney U test. RESULTS For both the right and left iliococcygeus, the T2* values of the patient group were lower than those of the control group (P = 0.002 and 0.008, respectively), while no significant difference was observed in the T2 values between the groups (P = 0.45 and 0.69, respectively). For both the right and left puborectalis, no significant differences in the T2* (P = 0.25 and P = 0.25, respectively) or T2 values (P = 0.38 and 0.43, respectively) were observed between the patient and control groups. CONCLUSION T2* mapping as a quantitative measurement is an effective imaging tool to assess LAM injury in women after vaginal delivery. The iliococcygeus was more susceptible to vaginal delivery damage than the puborectalis, and pelvic floor dysfunction may be mainly driven by iliococcygeus injury.
Collapse
Affiliation(s)
- Yuchao Li
- Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China; Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Tao Gong
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xueyan Lin
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xinhong Wei
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xianyun Cai
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xin Chen
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | | | - Guangbin Wang
- Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China; Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
| |
Collapse
|
4
|
Revels JW, Mansoori B, Fadl S, Wang SS, Olson MC, Moran SK, Terrazas MF, Fletcher JG, Perry WRG, Chernyak V, Mileto A. MR Defecating Proctography with Emphasis on Posterior Compartment Disorders. Radiographics 2023; 43:e220119. [DOI: 10.1148/rg.220119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
|
5
|
Cui C, Zhao Y, Cui D, Li N, Pan J, Shen W. In vivo evaluation of the levator ani muscle in primiparous women using diffusion tensor imaging and fiber tractography. Int J Gynaecol Obstet 2021; 157:663-670. [PMID: 34492120 DOI: 10.1002/ijgo.13897] [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: 05/17/2021] [Revised: 07/11/2021] [Accepted: 08/20/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To characterize the levator ani muscle (LAM) injury after first vaginal delivery and investigate the clinical application of diffusion tensor imaging (DTI) and fiber tractography in evaluating the LAM. METHODS Fifty-eight primiparous women at 6 weeks after vaginal delivery and 27 nulliparous women as controls underwent T2-weighted sequence and DTI sequence of the pelvic floor. A LAM scoring system was used to characterize the morphological changes. Fiber tractography of each major subdivision of LAM was performed, followed by assessment of the quality of fiber tracking. Fractional anisotropy (FA), apparent diffusion coefficient (ADC), fiber volume, and length were calculated. RESULTS Puborectalis and iliococcygeus injuries were observed in 30/58 (51.7%) and 10/58 (17.2%) primiparae, respectively. No LAM defects were identified in the control group. For the puborectalis, the FA values were lower (P = 0.010) and ADC values were higher (P = 0.024) in the primiparous group than in the control group. For the iliococcygeus, the fiber volume values were lower in the primiparous group than in the control group (P = 0.004). CONCLUSION Vaginal delivery can result in LAM injury at the puborectalis. DTI parameters can assist in the quantitative diagnosis of the LAM injury.
Collapse
Affiliation(s)
- Can Cui
- Department of Radiology, Affiliated JinHua Hospital, ZheJiang University School of Medicine (JinHua Municipal Central Hospital), JinHua, China
| | - Yujiao Zhao
- Department of Radiology, Tianjin First Center Hospital, Tianjin, China
| | - Dawei Cui
- Department of Obstetrics and Gynecology, Affiliated JinHua Hospital, ZheJiang University School of Medicine (JinHua Municipal Central Hospital), JinHua, China
| | - Na Li
- Department of Radiology, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiangfeng Pan
- Department of Radiology, Affiliated JinHua Hospital, ZheJiang University School of Medicine (JinHua Municipal Central Hospital), JinHua, China
| | - Wen Shen
- Department of Radiology, Tianjin First Center Hospital, Tianjin, China
| |
Collapse
|
6
|
Zhou B, Zhang H, Yuan J, Bu C, Lai W. Pelvic floor assessment using magnetic resonance imaging after vaginal delivery and elective caesarean delivery. Int Urogynecol J 2020; 32:3023-3029. [PMID: 32886174 DOI: 10.1007/s00192-020-04514-y] [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: 06/01/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We aimed to compare quantitative static and dynamic magnetic resonance imaging (MRI) measurements of pelvic floor changes during postpartum recovery from 1 week to 6 months after different modes of delivery. METHODS In this prospective study, 51 primiparous women (vaginal delivery group: 30 women; elective caesarean delivery group: 21 women) underwent static and dynamic MRI at 1 week, 6 weeks, 3 months, and 6 months postpartum to measure pelvic floor MRI values. Between-group differences in pelvic floor values at these time points were determined; subsequently, within-group comparisons according to time were performed. Analysis included independent samples t-tests and paired t-tests. RESULTS The puborectal hiatus line (H line), muscular pelvic floor relaxation line (M line), bladder-pubococcygeal line (B-PCL), and uterus-pubococcygeal line (U-PCL) differed significantly between groups during the Valsalva manoeuvre at 1 week postpartum (p < 0.05). The H line, M line, and B-PCL values differed significantly between groups during the Valsalva manoeuvre at 6 weeks postpartum (p < 0.05). There were few significant between-group differences in pelvic floor values at 3 months and 6 months postpartum. In the vaginal delivery group, the differences in the H line and M line at 1 week, 6 weeks, and 3 months postpartum were significant (p < 0.001). In the elective caesarean delivery group, U-PCL differed significantly at 6 weeks compared to 1 week postpartum during the Valsalva manoeuvre (p < 0.05). CONCLUSIONS Pelvic floor recovery primarily occurred during the early phase after delivery in both groups. Elective caesarean delivery had a non-significant protective effect on postpartum pelvic floor structure and function compared to vaginal delivery.
Collapse
Affiliation(s)
- Beibei Zhou
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-sen University, 628 Zhenyuan Road, Shenzhen, 518107, People's Republic of China
| | - Hongbo Zhang
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-sen University, 628 Zhenyuan Road, Shenzhen, 518107, People's Republic of China.
| | - Jianpeng Yuan
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-sen University, 628 Zhenyuan Road, Shenzhen, 518107, People's Republic of China
| | - Chao Bu
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-sen University, 628 Zhenyuan Road, Shenzhen, 518107, People's Republic of China
| | - Weijian Lai
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-sen University, 628 Zhenyuan Road, Shenzhen, 518107, People's Republic of China
| |
Collapse
|