OBJECTIVE: The purpose of this article is to review the anatomy and etiology of pelvic floor weakness in women and to discuss the role of MRI in the assessment of female pelvic floor dysfunction. CONCLUSION: In women with pelvic floor weakness, pelvic MRI, with its superior soft-tissue contrast resolution, allows direct visualization of the pelvic organs and their supportive structures in a single noninvasive examination. By providing useful and valuable information on the extent and severity of pelvic organ prolapse, MRI plays a valuable role in preoperative planning of complex cases.
"slicer.org, a open source software; Brigham and Women's Hospital, Boston, MA) was used to measure the PCL, H line, and M line on the midsagittal slice, according to the definitions described by Law and Fielding 3 in 2008. A representation of these reference lines is shown in Figure 1, A. The point in the posterior wall of the rectum, at the level of anorectaljunction,usedtodefinebothHline and M line is referred to as " Fielding point. "
[Show abstract][Hide abstract] ABSTRACT: We describe a new parameter based on magnetic resonance 3-dimensional (3D) reconstructions proposed to evaluate levator ani muscle (LAM) laxity in women with pelvic organ prolapse (POP).
This is an institutional review board-approved, retrospective chart review of 35 women with POP, stages I-IV. The 3D Slicer software package was used to perform 2-dimensional and 3D measurements and the levator ani subtended volume (LASV) was described. Basically, the LASV represents the volume contained by LAM between 2 planes, which coincides with pubococcygeal line and H line. Correlations among measurements, ordinal POP stages, POP Quantification (POPQ) individual measurements, and validated questionnaires were performed.
The LASV differentiated major (III and IV) from minor (I and II) POPQ stages, which positively correlated to POP stages and POPQ individual measurements.
The LASV is a promising parameter to evaluate the LAM laxity.
American journal of obstetrics and gynecology 10/2011; 206(3):244.e1-9. DOI:10.1016/j.ajog.2011.10.001 · 4.70 Impact Factor
"Furthermore, in a study on the comparison of POP-Q and ultrasound staging of prolapse, the two methods performed similar with regards to the identification of women with the sensation or visualization of a lump in the vagina . Dynamic MR imaging of the pelvic floor is another potentially useful diagnostic tool in the preoperative assessment of pelvic floor dysfunction . Until now, however, there are no studies available, which have assessed the agreement between measurements on dynamic MR imaging and patients’ symptoms. "
[Show abstract][Hide abstract] ABSTRACT: The aim of the study was to determine whether patients' symptoms agree with findings on clinical examination and dynamic MR imaging of the pelvic floor.
Symptoms of pelvic organ dysfunction were measured with the use of three validated questionnaires. The domain scores were compared with POP-Q and dynamic MR imaging measurements. The Spearman's rank correlation coefficient (r(s)) was used to assess agreement.
Only the domain score genital prolapse was significantly correlated in the positive direction with the degree of pelvic organ prolapse as assessed by POP-Q and dynamic MR imaging (r(s) = 0.64 and 0.27, respectively), whereas the domain score urinary incontinence was inversely correlated (r(s) = -0.32 and -0.35, respectively).
The sensation or visualization of a bulge in the vagina was the only symptom which correlated positively with the degree of pelvic organ prolapse, and clinical examination and dynamic MR imaging showed similar correlation in this respect.
International Urogynecology Journal 08/2009; 20(10):1169-74. DOI:10.1007/s00192-009-0938-2 · 1.96 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: L’IRM pelvienne dynamique tient un rôle croissant dans l’évaluation pré et post thérapeutique des troubles de la statique pelvienne (TSP). Elle permet une analyse simultanée des structures de soutien du plancher pelvien et des trois filières pelviennes, ainsi que du compartiment péritonéal. Sa réalisation est nécessaire devant des situations cliniques complexes, suspicion d’atteinte pluri- compartimentale, incontinences urinaires et anales sévères, prolapsus. Pour certain, elle fait partie de tout bilan pré-opératoire de prolapsus, notamment pour sa capacité à différentier entérocèle et rectocèle en cas de colpocèle postérieure clinique. Enfin elle doit être réalisée en cas de récidive postopératoire.
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