Improved Detection of Pelvic Organ Prolapse: Comparative Utility of Defecography Phase Sequence to Nondefecography Valsalva Maneuvers in Dynamic Pelvic Floor Magnetic Resonance Imaging.
Adult
Age Factors
Aged
Cohort Studies
Defecography
/ statistics & numerical data
Female
Humans
Magnetic Resonance Imaging
/ statistics & numerical data
Middle Aged
Pelvic Organ Prolapse
/ diagnosis
Physical Examination
/ methods
Rectal Prolapse
/ diagnosis
Retrospective Studies
Risk Factors
Sensitivity and Specificity
Severity of Illness Index
Uterine Prolapse
/ diagnosis
Valsalva Maneuver
Journal
Current problems in diagnostic radiology
ISSN: 1535-6302
Titre abrégé: Curr Probl Diagn Radiol
Pays: United States
ID NLM: 7607123
Informations de publication
Date de publication:
Historique:
received:
16
04
2018
revised:
16
08
2018
accepted:
16
08
2018
pubmed:
23
9
2018
medline:
20
12
2019
entrez:
23
9
2018
Statut:
ppublish
Résumé
To evaluate the utility of a defecography phase (DP) sequence in dynamic pelvic floor MRI (DPMRI), in comparison to DPMRI utilizing only non-defecography Valsalva maneuvers (VM). Inclusion criteria identified 237 female patients with symptoms and/or physical exam findings of pelvic floor prolapse. All DPMRI exams were obtained following insertion of ultrasound gel into the rectum and vagina. Steady-state free-precession sequences in sagittal plane were acquired in the resting state, followed by dynamic cine acquisitions during VM and DP. In all phases, two experienced radiologists performed blinded review using the H-line, M-line, Organ prolapse (HMO) system. The presence of a rectocele, enterocele and inferior descent of the anorectal junction, bladder base, and vaginal vault were recorded in all patients using the pubococcygeal line as a fixed landmark. DPMRI with DP detected significantly more number of patients than VM (p<0.0001) with vaginal prolapse (231/237, 97.5% vs. 177/237, 74.7%), anorectal prolapse (227/237, 95.8% vs. 197/237, 83.1%), cystocele (197/237, 83.1% vs. 108/237, 45.6%), and rectocele (154/237, 65% vs. 93/237, 39.2%). The median cycstocele (3.2cm vs. 1cm), vaginal prolapse (3cm vs. 1.5cm), anorectal prolapse (5.4cm vs. 4.2cm), H-line (8cm vs. 7.2cm) and M-line (5.3cm vs. 3.9cm) were significantly higher with DP than VM (p<0.0001). Addition of DP to DPMRI demonstrates a greater degree of pelvic floor instability as compared to imaging performed during VM alone. Pelvic floor structures may show mild descent or appear normal during VM, with marked prolapse on subsequent DP images.
Identifiants
pubmed: 30241870
pii: S0363-0188(18)30112-9
doi: 10.1067/j.cpradiol.2018.08.005
pmc: PMC8177730
mid: NIHMS1708056
pii:
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
342-347Subventions
Organisme : NIGMS NIH HHS
ID : P41 GM103712
Pays : United States
Informations de copyright
Copyright © 2018. Published by Elsevier Inc.
Références
Abdom Radiol (NY). 2016 Feb;41(2):215-20
pubmed: 26867902
AJR Am J Roentgenol. 2011 Apr;196(4):W394-9
pubmed: 21427302
Radiographics. 2000 Nov-Dec;20(6):1567-82
pubmed: 11112811
Int Braz J Urol. 2002 Nov-Dec;28(6):553-9
pubmed: 15748406
J Magn Reson Imaging. 1999 Mar;9(3):373-7
pubmed: 10194705
Urology. 1999 Sep;54(3):454-7
pubmed: 10475353
AJR Am J Roentgenol. 2008 Dec;191(6 Suppl):S45-53
pubmed: 19018049
Abdom Imaging. 2007 Nov;32(6):775-83
pubmed: 17151893
Radiology. 2006 Aug;240(2):449-57
pubmed: 16801366
Int J Surg. 2010;8(4):274-82
pubmed: 20219700
Radiographics. 2014 Mar-Apr;34(2):429-48
pubmed: 24617690
Eur Radiol. 2017 May;27(5):2067-2085
pubmed: 27488850