MRI of pelvic floor dysfunction: Dynamic true fast imaging with steady-state precession versus HASTE
ABSTRACT The objective of our study was to retrospectively compare the degree of pelvic organ prolapse shown on dynamic true fast imaging with steady-state precession (FISP) versus HASTE sequences in symptomatic patients.
Fifty-nine women (mean age, 57 years) with suspected pelvic floor dysfunction underwent MRI using both a sagittal true FISP sequence, acquired continuously during rest alternating with the Valsalva maneuver, and a sagittal HASTE sequence, acquired sequentially at rest and at maximal strain. Data sets were evaluated in random order by two radiologists in consensus using the pubococcygeal line (PCL) as a reference. Measurement of prolapse was based on a numeric grading system indicating severity as follows: no prolapse, 0; mild, 1; moderate, 2; or severe, 3. A comparison between sequences on a per-patient basis was performed using a Wilcoxon's analysis with p < 0.05 considered significant.
Overall, 66.1% (39/59) of patients had more severe prolapse (>or= 1 degrees ) based on dynamic true FISP images, with 28.8% (17/59) of the cases of prolapse seen exclusively on true FISP images. Only 20.3% (12/59) of patients had greater degrees of prolapse on HASTE images than on true FISP images, with 10.2% (6/59) of the cases seen exclusively on HASTE images. A statistically significant increase in the severity of cystoceles (p < 0.01) and urethral hypermobility (p < 0.01)-with a trend toward more severe urethroceles (p < 0.07), vaginal prolapse (p < 0.09), and rectal descent (p < 0.06)-was shown on true FISP images.
Overall, greater degrees of organ prolapse in all three compartments were found with a dynamic true FISP sequence compared with a sequential HASTE sequence. Near real-time continuous imaging with a dynamic true FISP sequence should be included in MR protocols to evaluate pelvic floor dysfunction in addition to dynamic multiplanar HASTE sequences.
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ABSTRACT: Pelvic Floor Disorders (PFD) are a major public health problem in the world and decrease seriously the patient's quality of life. In case of recurrence after surgery or complex prolapse, imaging techniques can be used. Dynamic MRI, introduced in the early 1990s, offers information of the four compartments of the pelvis with a high resolution and a direct visualization of muscles and fascias in multiple planes. But for a practical use, such an expensive exam should be well correlated to symptoms and clinical examination or change surgical approach. The aim of our review was to precise the evidence regarding techniques, and indication of dynamic MRI in the assessment of pelvic floor disorders in daily practice. The first part is a review of available studies on methods of carrying out the dynamic MRI. The second part consists on the comparison of dynamic MRI to other assessment methods in case of pelvic floor disorders. Results emphasize the lack of strong level studies about the interest of dynamic MRI in the diagnosis and surgical management of pelvic organ prolapse. Although dynamic MRI appears highly reproducible between examiners, especially for the anterior compartment, its correlation with the degree of prolapse or the symptoms appears low. The most interesting field of application seems the detection of levator ani (LA) avulsion with a higher risk of prolapse and recidive in case of LA defects. More prospective, randomized, comparative studies have to be done.European Journal of Obstetrics & Gynecology and Reproductive Biology 10/2014; 181:259–266. DOI:10.1016/j.ejogrb.2014.07.025 · 1.63 Impact Factor
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ABSTRACT: Physical examination alone is often inadequate for evaluation of pelvic floor dysfunction. Magnetic resonance imaging (MRI) is a robust modality that can provide high-quality anatomic and functional evaluation of the pelvic floor. Although lack of standardized technique and radiologist inexperience may be relative deterrents in universal acceptance of pelvic floor MRI, the role of MRI is increasing as it is technically feasible on most magnets and offers some advantages over the traditional fluoroscopic defecography. This review focuses on the technical and interpretational aspects of anatomic and functional pelvic floor MRI.Topics in magnetic resonance imaging: TMRI 08/2014; 23(4):259-73. DOI:10.1097/RMR.0000000000000030
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ABSTRACT: Pelvic floor weakness is a functional condition that affects the anatomic structures supporting the pelvic organs: fasciae, ligaments, and muscles. It is a prevalent disorder among people older than 50 years, especially women, and may substantially diminish their quality of life. Many complex causes of pelvic floor weakness have been described, but the greatest risk factors are aging and female sex. Pelvic floor weakness can provoke a wide range of symptoms, including pain, urinary and fecal incontinence, constipation, difficulty in voiding, a sense of pressure, and sexual dysfunction. When the condition is diagnosed solely on the basis of physical and clinical examination, the compartments involved and the site of prolapse are frequently misidentified. Such errors contribute to a high number of failed interventions. Magnetic resonance (MR) imaging, which allows visualization of all three compartments, has proved a reliable technique for accurate diagnosis, especially when involvement of multiple compartments is suspected. MR imaging allows precise evaluation of ligaments, muscles, and pelvic organs and provides accurate information for appropriate surgical treatment. Moreover, dynamic MR imaging with steady-state sequences enables the evaluation of functional disorders of the pelvic floor. The authors review the pelvic floor anatomy, describe the MR imaging protocol used in their institutions, survey common MR imaging findings in the presence of pelvic floor weakness, and highlight key details that radiologists should provide surgeons to ensure effective treatment and improved outcomes. Online supplemental material is available for this article. ©RSNA, 2014.
Elizabeth M Hecht