Dynamic MR imaging of female organ prolapse

The feasibility of uterine-vaginal axis MRI-based as evaluation of surgical efficacy in women with pelvic organ prolapse

Background

The aim of this study was to provide a potential surgical efficacy assessment in the treatment of pelvic organ prolapse (POP).

Methods

A retrospective cohort study was performed on magnetic resonance imaging (MRI) imaging data of 16 non-prolapsed (control group) and 30 preoperative and postoperative POP (case group) women from 2019 to 2021 at the First Affiliated Hospital of Kunming Medical University. MRI diagnoses and measures of the relevant anatomical points at rest were used to analyze the healthy control data and the data from POP women before and after surgery.

Results

The middle vaginal-PICS line angle (78.12°±15.03° vs. 69.35°±11.51°, 78.12°±15.03° vs. 61.56°±9.58°, P<0.05) and the middle-lower vaginal angle (179.30°±12.96° vs. 161.73°±10.42°, 179.30°±12.96° vs. 147.01°±12.20°, P<0.05) in the preoperative group were significantly larger than those in the control and postoperative groups. Y-axis coordinates of the endocervical orifice (−52.39±15.63 vs. −59.04±11.49 mm, −52.39±15.63 vs. −65.27±7.25 mm, P<0.05), posterior vaginal fornix (−34.25±13.30 vs. −46.69±11.09 mm, −34.25±13.30 vs. −49.93±8.02 mm, P<0.05), the junction of the middle and lower vagina (−0.48±8.65 vs. −11.34±7.33 mm, −0.48±8.65 vs. −10.11±9.77 mm, P<0.05), and anterior vaginal fornix (−23.14±13.71 vs. −34.68±9.07 mm, −23.14±13.71 vs. −38.64±6.48 mm, P<0.05), as well as the x-axes of the junction of the middle and lower parts of the vagina (26.79±6.71 vs. 19.56±5.24, 26.79±6.71 vs. 17.67±5.81, P<0.05), and vaginal introitus (23.39±7.12 vs. 18.55±4.22, 23.39±7.12 vs. 19.00±4.55, P<0.05) in the preoperative group were smaller than those of the control and postoperative groups. Differences between the control and postoperative groups were not statistically significant (P>0.05).

Conclusions

The current study established that the uterine-vaginal axis of POP women moved backward and downward in the coordinate system, as shown on MRI sagittal images. Further, it moved forward and upwards after surgical repair and more closely resembled that of the control group. The uterine-vaginal axis may provide an evaluation of surgical efficacy in women with POP.

Comparison of the Axes and Positions of the Uterus and Vagina Between Women With and Without Pelvic Floor Organ Prolapse

Purpose

To analyze the role of the axial positions of the uterus and vagina in providing pelvic floor support, encourage evaluations of pelvic floor function, and improve the understanding of the pathogenesis of pelvic organ prolapse.

Methods

The lengths and angles of the upper, middle, and lower axes of the vagina, uterine body, and cervix of 81 women with prolapse (prolapse group) and 57 women without prolapse (non-prolapse group) were measured and compared using magnetic resonance images. The pelvic inclination correction system (PICS) line was also compared between the groups. The coordinate parameters of the anatomical points of the uterus and vagina were measured, and their positions were analyzed.

Results

In the prolapse group, the uterine body-cervical angle, cervical-upper vaginal angle, uterine body-PICS line angle, cervical-PICS line angle, and lower vaginal-PICS line angle were smaller (p < 0.05) and the middle-lower vaginal angle, upper vaginal-PICS line angle, and middle vaginal-PICS line angles were larger (p < 0.05) than those in the non-prolapse group. The cervical length was longer (p < 0.05) and the middle and lower vaginal lengths were shorter (p < 0.05) in the prolapse group. The coordinate system revealed that the uterine and vaginal axes were shifted backward and downward in the prolapse group.

Conclusion

Patients in the prolapse group were more likely to have retroversion and retroflexion of the uterus than those in the non-prolapse group. The vagina was shortened, turned forward, and straightened, and the uterus and vagina were shifted backward and downward in the prolapse group. Changes in the axial position of the uterus and vagina are important mechanisms of pelvic floor organ prolapse.

Comparison of magnetic resonance defecography grading with POP-Q staging and Baden-Walker grading in the evaluation of female pelvic organ prolapse

PURPOSE

The physical examination and pelvic imaging with MRI are often used in the pre-operative evaluation of pelvic organ prolapse. The objective of this study was to compare grading of prolapse on defecography phase of dynamic magnetic resonance imaging (dMRI) with physical examination (PE) grading using both the Pelvic Organ Prolapse Quantification (POP-Q) staging and Baden-Walker (BW) grading systems in the evaluation of pelvic organ prolapse (POP).

METHODS

We retrospectively reviewed the charts of 170 patients who underwent dMRI at our institution. BW grading and POP-Q staging were collected for anterior, apical, and posterior compartments, along with absolute dMRI values and overall grading of dMRI. For the overall grading/staging from dMRI, BW, and POP-Q, Spearman rho (ρ) was used to assess the correlation. The correlations between dMRI grading and POP-Q staging were compared to the correlations between dMRI grading and BW grading using Fisher's Z transformation.

RESULTS

A total of 54 patients were included. dMRI grading was not significantly correlated with BW grading for anterior, apical, and posterior compartment prolapse (p > 0.15). However, overall dMRI grading demonstrated a significant (p = 0.025) and positive correlation (ρ = 0.305) with the POP-Q staging system. dMRI grading for anterior compartment prolapse also demonstrated a positive correlation (p = 0.001, ρ = 0.436) with the POP-Q staging derived from measurement locations Aa and Ba. The overall dMRI grade is better correlated with POP-Q stage than with BW grade (p = 0.024).

CONCLUSION

Overall and anterior compartment grading from dMRI demonstrated a significant and positive correlation with the overall POP-Q staging and anterior compartment POP-Q staging, respectively. The overall dMRI grade is better correlated with POP-Q staging than with BW grading.

MRI suggests increased tonicity of the levator ani in women with interstitial cystitis/bladder pain syndrome

INTRODUCTION AND HYPOTHESIS

In interstitial cystitis/bladder pain syndrome (IC/BPS), pelvic floor dysfunction may contribute significantly to pelvic pain. To determine if pelvic floor hypertonicity manifests alterations on magnetic resonance imaging (MRI) in patients with IC/BPS, we retrospectively compared pelvic measurements between patients and controls.

METHODS

Fifteen women with IC/BPS and 15 age-matched controls underwent pelvic MRI. Two blinded radiologists measured the pelvic musculature, including the H- and M lines, vaginal length, urethral length and cross-sectional area, levator width and length, and posterior puborectalis angle. MRI measures and clinical factors, such as age, parity, and duration of symptoms, were compared using a paired, two-tailed t test.

RESULTS

There were no significant differences in age, parity, or symptom duration between groups. Patients with IC/BPS exhibited shorter levator muscles (right: 5.0 ± 0.7 vs. 5.6 ± 0.8, left: 5.0 ± 0.8 vs. 5.7 ± 0.8 cm, P < 0.002) and a wider posterior puborectalis angle (35.0 ± 8.6 vs. 26.7 ± 7.9°, P < 0.01) compared with controls. The H line was shorter in patients with IC/BPS (7.8 ± 0.8 vs. 8.6 ± 0.9 cm, P < 0.02), while M line did not differ. Total urethral length was similar, but vaginal cuff and bladder neck distances to the H line were longer in patients with IC/BPS (5.7 ± 0.6 vs. 5.1 ± 0.9 cm, P < 0.02; 1.9 ± 0.4 vs. 1.4 ± 0.2 cm, P < 0.001, respectively).

CONCLUSIONS

Patients with IC/BPS have pelvic floor hypertonicity on MRI, which manifests as shortened levator, increased posterior puborectalis angles, and decreased puborectal distances. We identified evidence of pelvic floor hypertonicity in patients with IC/BPS, which may contribute to or amplify pelvic pain. Future studies are necessary to determine the MRI utility in understanding pelvic floor hypertonicity in patients with IC/BPS.

Dynamic magnetic resonance imaging of pelvic organ prolapse: recent research progress

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.

[Diagnostic radiology of the pelvis. Prostate cancer, bladder cancer, and incontinence]

Prostate cancer, bladder cancer, and pelvic floor weakness are among the most common diseases of the pelvis. Cardinal symptoms include painless macrohematuria in bladder cancer and urinary and fecal incontinence in pelvic floor weakness. Suspicion of prostate cancer currently is most frequently raised when the serum concentration of prostate-specific antigen is pathologically elevated. Besides extensive clinical and invasive diagnosis, clinical imaging is frequently applied for the localization, locoregional staging, and diagnosis of recurrence of prostate cancer and invasive bladder cancer, and in clinically difficult cases of cystocele, enterocele, rectocele, descensus or prolapse of vagina, uterus, and rectum, and rectal intussusception. Magnetic resonance imaging with T2-weighted TSE or FSE images in several planes combined with either axial, T1-weighted images and MR spectroscopy for the prostate, dynamic contrast-enhanced T1-weighted images for the urinary bladder, or dynamic T2-weighted functional images for pelvic floor incontinence are particularly well suited as clinical imaging methods.