MRI of pelvic floor dysfunction: review.

Department of Diagnostic Radiology, Singapore General Hospital, Outram Rd., Singapore 169608, Republic of Singapore.
American Journal of Roentgenology (Impact Factor: 2.9). 12/2008; 191(6 Suppl):S45-53. DOI: 10.2214/AJR.07.7096
Source: PubMed

ABSTRACT 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.

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    ABSTRACT: The objective of this study is to compare levator hiatus measurements between pelvic magnetic resonance imaging (MRI) and pelvic ultrasound (US) imaging modalities.
    Female pelvic medicine & reconstructive surgery. 07/2014; 20(4):216-221.
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    ABSTRACT: Introduction Pelvic floor dysfunction and prolapse affect about 50% of women past middle age. Failure to recognize the complex set of pelvic floor defects in individuals leads to most postsurgical failures. Diagnosis and grading of pelvic floor dysfunction is primarily done by physical examination. Imaging does not have yet an established role in the investigation of prolapse, yet it is expected to play a role in preoperative planning identifying soft tissue abnormalities which will help avoiding recurrence. Aim of the work This is a prospective study targeted at defining the role of MRI in assessment of pelvic floor prolapse in females. Methods Dynamic and static MRI was performed in 40 female patients complaining of pelvic organ prolapse and/or stress urinary incontinence or fecal incontinence. Full history was taken and clinical examination performed and findings compared with MRI results. Results Good concordance was found between dynamic MRI and clinical examination in all three compartments, it was 82.5% in the anterior compartment, 80% in the posterior compartment, 85% in enteroceles and 65.0% in the middle compartment. Conclusion Dynamic MRI is expected to be a promising imaging tool and to play a larger role in the preoperative planning of pelvic organ prolapse in the near future.
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    ABSTRACT: This study describes a technique to quantify muscle fascicle directions in the levator ani (LA) and tests the null hypothesis that the in vivo fascicle directions for each LA subdivision subtend the same parasagittal angle relative to a horizontal reference axis. Visible muscle fascicle direction in the each of the three LA muscle subdivisions, the pubovisceral (PVM; synonymous with pubococcygeal), puborectal (PRM), and iliococcygeal (ICM) muscles, as well as the external anal sphincter (EAS), were measured on 3-T sagittal MRI images in a convenience sample of 14 healthy women in whom muscle fascicles were visible. Mean ± standard deviation (SD) angle values relative to the horizontal were calculated for each muscle subdivision. Repeated measures ANOVA and post-hoc paired t tests were used to compare muscle groups. Pubovisceral muscle fiber inclination was 41 ± 8.0°, PRM was -19 ± 10.1°, ICM was 33 ± 8.8°, and EAS was -43 ± 6.4°. These fascicle directions were statistically different (p < 0.001). Pairwise comparisons among levator subdivisions showed angle differences of 60° between PVM and PRM, and 52° between ICM and PRM. An 84° difference existed between PVM and EAS. The smallest angle difference between levator divisions was between PVM and ICM 8°. The difference between PRM and EAS was 24°. All pairwise comparisons were significant (p < 0.001). The null hypothesis that muscle fascicle inclinations are similar in the three subdivisions of the levator ani and the external anal sphincter was rejected. The largest difference in levator subdivision inclination, 60°, was found between the PVM and PRM.
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