Hina Arif-Tiwari1, Christian O Twiss2, Frank C Lin3, Joel T Funk4, Srinivasan Vedantham5, Diego R Martin6, Bobby T Kalb7. 1. Department of Medical Imaging, University of Arizona, College of Medicine, Tucson, AZ; Department of Surgery, University of Arizona, Banner University Medicine, Tucson, AZ. Electronic address: hinaarif@radiology.arizona.edu. 2. Department of Surgery, Section of Urology, University of Arizona Medical Center, Tucson, AZ. Electronic address: ctwiss@surgery.arizona.edu. 3. Division of Urology, Department of Surgery, University of Arizona, Banner University Medicine, Tucson, AZ. Electronic address: flin@email.arizona.edu. 4. Division of Urology, Department of Surgery, University of Arizona, Banner University Medicine, Tucson, AZ. Electronic address: jfunk@surgery.arizona.edu. 5. Department of Medical Imaging, University of Arizona, College of Medicine, Tucson, AZ. Electronic address: svedantham@radiology.arizona.edu. 6. College of Medicine, University of Arizona, Banner University Medicine, Tucson, AZ. Electronic address: dmartin@radiology.arizona.edu. 7. College of Medicine, University of Arizona, Tucson, AZ. Electronic address: bkalb@radiology.arizona.edu.
Abstract
PURPOSE: 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). MATERIALS AND METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
PURPOSE: 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). MATERIALS AND METHODS: 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. RESULTS: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). CONCLUSIONS: 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.
Authors: Franc H Hetzer; Gustav Andreisek; Christina Tsagari; Ulli Sahrbacher; Dominik Weishaupt Journal: Radiology Date: 2006-06-26 Impact factor: 11.105
Authors: Brooke H Gurland; Gaurav Khatri; Roopa Ram; Tracy L Hull; Ervin Kocjancic; Lieschen H Quiroz; Rania F El Sayed; Kedar R Jambhekar; Victoria Chernyak; Raj Mohan Paspulati; Vipul R Sheth; Ari M Steiner; Amita Kamath; S Abbas Shobeiri; Milena M Weinstein; Liliana Bordeianou Journal: Int Urogynecol J Date: 2021-10 Impact factor: 2.894
Authors: Gaurav Khatri; Neil M Kumar; Yin Xi; William Smith; Chasta Bacsu; April A Bailey; Philippe E Zimmern; Ivan Pedrosa Journal: Abdom Radiol (NY) Date: 2021-04
Authors: Ekaterina Stansfield; Barbara Fischer; Nicole D S Grunstra; Maria Villa Pouca; Philipp Mitteroecker Journal: BMC Biol Date: 2021-10-11 Impact factor: 7.431