Magnetic resonance imaging of pelvic floor disorders

How to develop and sustain a successful pelvic floor MRI practice

PURPOSE

Magnetic resonance imaging (MRI) of the pelvic floor has become a commonly requested diagnostic tool for pelvic floor assessment. We provide a practical guide for developing, growing, and troubleshooting a dedicated pelvic floor imaging service.

METHODS

The authors provide an organized approach to the development of a pelvic floor MRI program based on the experience of the SAR Pelvic Floor Disease Focused Panel in academic and private practice settings. Topics addressed include creating interest, staff education, patient preparation both before and after arrival to the imaging center, image acquisition, reporting, and troubleshooting.

RESULTS

Using the organization and approach in this guide, the challenge of growing this relatively complex imaging program can be simplified. Familiarity with best practices and established techniques used by successful programs will allow new sites to avoid early pitfalls and quickly develop a mature and autonomous workflow.

CONCLUSIONS

The development and growing of a pelvic floor MRI program presents its own set of challenges and unique workflow issues which can create anxiety in both patients and providers. We systematically present an approach to streamline the development of a successful pelvic floor MRI program.

Application of dynamic MRI defecography in diagnosis of outlet obstructive constipation

AIM

To assess the application value of dynamic magnetic resonance imaging (MRI) defecography in the diagnosis of outlet obstructive constipation (OCC).

METHODS

Forty-eight patients with suspected OOC at Third Affiliated Hospital of Nanchang University from March 2016 to February 2018 were selected, and they underwent dynamic MRI defecography and X-ray defecography. The situations of dynamic MRI defecography and X-ray defecography were recorded. Using X-ray defecography as the standard, the specificity, sensitivity, negative predictive value, and positive predictive value of dynamic MRI defecography were calculated.

RESULTS

There was no statistical difference in the diagnosis of intersigmoid hernia, puborectalis spasm, hernia, or internal hemorrhoid between dynamic MRI defecography and X-ray defecography (P > 0.05). The detection rates of dynamic MRI defecography in the diagnosis of rectocele, rectal mucosal prolapse, perinaeum descent, intrarectal invaginate, and sigmoid colon zigzagging were lower than those of X-ray defecography (P < 0.05). Dynamic MRI defecography could find lesions that cannot be displayed by X-ray defecography, including muscular rupture, uterine fibroid, cervical accepts cyst, sacral cyst, and mullerian duct cyst. Using X-ray defecography as the gold standard, the specificity and positive predictive value of dynamic MRI defecography in the diagnosis of rectal mucosal prolapse, rectocele, puborectalis spasm, intrarectal invaginate, intersigmoid hernia, hernia, sigmoid colon zigzagging, and perinaeum descent were all 100.00%; the sensitivity and positive predictive value for different diseases had a significant difference, the positive predictive value was generally higher, and the sensitivity was usually lower.

CONCLUSION

MRI and X-ray defecography have their own advantages in the diagnosis of OOC. Dynamic MRI defecography can provide information on the pelvic organ and pelvic wall, pelvic floor function, and morphological structure, and it is a good supplement to X-ray defecography. Dynamic MRI defecography can provide guidance for overall evaluation and comprehensive diagnosis of OOC with pelvic multiple-organ lesions.

Endoluminal contrast for abdomen and pelvis magnetic resonance imaging

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.