Article

Identificação das estruturas músculo-ligamentares do assoalho pélvico feminino na ressonância magnética

Radiologia Brasileira 01/2001; DOI: 10.1590/S0100-39842001000600004
Source: DOAJ

ABSTRACT OBJETIVO: Determinar a freqüência de identificação das estruturas músculo-ligamentares do assoalho pélvico por meio de exames de ressonância magnética e avaliar o índice de concordância entre os observadores. MÉTODO: Estudo prospectivo em 20 voluntárias assintomáticas, idade de 20 a 80 anos (média de 50 anos). Realizados exames de ressonância magnética pélvica (1,5 T) nas seqüências turbo spin-eco ponderadas em T1 e T2 nos planos axial e sagital. Os exames foram avaliados por dois observadores independentes, que procuraram identificar os músculos levantador do ânus (músculos coccígeo, pubococcígeo, iliococcígeo e puborretal), obturador interno e compressor da uretra e os ligamentos pubovesical e pubouretral. Os resultados foram comparados com base na freqüência de identificação das estruturas anatômicas e na concordância entre os observadores (índice kappa -- kapa). RESULTADOS: A freqüência de identificação das estruturas variou de 50% a 100%, sendo pouco inferior para os ligamentos. A concordância interobservador na identificação das estruturas foi a seguinte: músculos levantador do ânus e obturador interno (kapa=1), pubococcígeo (kapa=0,62), iliococcígeo (kapa=0,86), puborretal (kapa=0,27), coccígeo (kapa=0) e compressor da uretra (kapa=1), e ligamentos pubovesical (kapa=0,50) e pubouretral (kapa=0,58). CONCLUSÃO: A ressonância magnética de pelve permite identificar as principais estruturas músculo-ligamentares do assoalho pélvico na grande maioria dos indivíduos, com boa concordância interobservador.

1 Bookmark
 · 
570 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: A greater awareness of the therapies now available for pelvic floor dysfunction has increased demand for specialized imaging of this region. Some of the techniques required are available at relatively few centers, and the purpose of this review is to introduce the emerging subspecialty of pelvic floor imaging to a more general readership. Pelvic floor anatomy is complex and is being unraveled by means of magnetic resonance (MR) imaging. This is discussed in detail by using a global, rather than a compartmentalized, anatomic approach. The physiology of normal urinary and anal function and the routine clinical tests applied to them are outlined. The imaging techniques involved include MR imaging, endosonography, and fluoroscopy. The main investigations include video urodynamic imaging, evacuation proctography, dynamic cystoproctography, dynamic MR imaging of the pelvic floor, and endoluminal imaging of the anal sphincters with MR imaging and ultrasonography. These are described in detail, and their role with regard to the main pathologic conditions of the pelvic floor--urinary and anal incontinence, constipation, and prolapse--are discussed.
    Radiology 04/2001; 218(3):621-41. · 6.34 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Alternations of the pelvic structure with an emphasis on those of the levator ani muscle, associated with uterine prolapse, were studied using sagittal magnetic resonance images obtained from 19 subjects without and 14 with uterine or vaginal prolapse of varied degree and 3 patients with Rokitansky syndrome who had undergone a McIndoe operation. Two additional patients with a grade III uterine prolapse were also studied before and 2-3 months after corrective surgery consisting of vaginal hysterectomy combined with anterior colporrhaphy and posterior colpoperineorrhaphy. Absence or presence of prolapse, irrespective of its grade, was found to be related to whether or not a reference line extrapolated from the levator plate crossed the pubis on sagittal images. This was the case as well in patients with Rokitansky syndrome with a neovagina and loss of such crossings was restored in patients with prolapse after surgery. Backward bending of the upper vagina noted in nonprolapse conditions was usually absent in patients with uterine prolapse. These results document that topographical changes involving the levator ani muscle and the vagina occur in association with uterine prolapse.
    Gynecologic and Obstetric Investigation 02/1992; 34(1):43-8. · 1.10 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To define in women the anatomy of the levator ani muscle visible on magnetic resonance imaging (MRI) so these muscles can be studied in women with prolapse or incontinence. Multiplanar T1- and T2-weighted MRI was obtained of two female pelvic cadaver specimens, ages 25 and 33. One specimen was hemisected, with half sectioned in the axial plane and the other half in the coronal plane. The other specimen was sectioned in the coronal plane. Anatomic cross sections of these specimens were correlated with the cadaver MRI and MRI of living patients. One sagittal and two axial series of anatomic sections not imaged were also used for comparison. Serial sagittal and axial MRI demonstrates the pubovisceralis ("pubococcygeus") muscle as it originates from the pubic bone, passes alongside the urethra, vagina, and rectum, and then dorsal to the anorectum. Its muscle bulk, attachment to the distal half of the vagina, and insertion between the internal and external anal sphincters can be seen on axial views. The origin of the iliococcygeus muscle at the arcus tendineus levator ani is seen in axial and coronal images. Coronal and sagittal images demonstrate the relative thickness and medial position of the pubovisceralis muscle compared with the thin, diaphragm-like lateral iliococcygeus muscle. Magnetic resonance imaging of the cadaver pelvis demonstrates the detailed anatomy of the levator ani muscle. This is an important precursor to future research of the structure, bulk, and orientation of the levator ani in living women with prolapse.
    Obstetrics and Gynecology 03/1996; 87(2):277-85. · 4.80 Impact Factor

Full-text (2 Sources)

Download
48 Downloads
Available from
May 20, 2014