Skip to main content

Advertisement

SpringerLink
Log in

Consensus definitions and interpretation templates for magnetic resonance imaging of Defecatory pelvic floor disorders

Proceedings of the consensus meeting of the pelvic floor disorders consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the international continence society, the American Urogynecologic Society, the international Urogynecological association, and the Society of Gynecologic Surgeons

  • Joint Publication
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

References

  1. Colaiacomo MC, Masselli G, Polettini E, Lanciotti S, Casciani E, Bertini L, Gualdi G. Dynamic MR imaging of the pelvic floor: a pictorial review. Radiographics. 2009;29:e35.

    Article  PubMed  Google Scholar 

  2. Lalwani N, Khatri G, El Sayed RF, et al. MR defecography technique: recommendations of the society of abdominal radiology’s disease-focused panel on pelvic floor imaging. Abdom Radiol (NY). 2021;46:1351–61. https://doi.org/10.1007/s00261-019-02160-7.

    Article  Google Scholar 

  3. El Sayed RF, Alt CD, Maccioni F. Et al; ESUR and ESGAR pelvic floor working group. Magnetic resonance imaging of pelvic floor dysfunction - joint recommendations of the ESUR and ESGAR pelvic floor working group. Eur Radiol. 2017;27:2067–85.

    Article  PubMed  Google Scholar 

  4. Ramage L, Simillis C, Yen C, Lutterodt C, Qiu S, Tan E, Kontovounisios C, Tekkis P. Magnetic resonance defecography versus clinical examination and fluoroscopy: a systematic review and meta-analysis. Tech Coloproctol. 2017;21:915–27.

    Article  CAS  PubMed  Google Scholar 

  5. Iacobellis F, Brillantino A, Renzi A, et al. MR imaging in diagnosis of pelvic floor descent: supine versus sitting position. Gastroenterol Res Pract. 2016;2016:6594152.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Gufler H, Ohde A, Grau G, Grossmann A. Colpocystoproctography in the upright and supine positions correlated with dynamic MRI of the pelvic floor. Eur J Radiol. 2004;51:41–7.

    Article  PubMed  Google Scholar 

  7. Kelvin FM, Maglinte DD, Hale DS, Benson JT. Female pelvic organ prolapse: a comparison of triphasic dynamic MR imaging and triphasic fluoroscopic cystocolpoproctography. AJR Am J Roentgenol. 2000;174:81–8.

    Article  CAS  PubMed  Google Scholar 

  8. Kumar NM, Khatri G, Christie AL, Sims R, Pedrosa I, Zimmern PE. Supine magnetic resonance defecography for evaluation of anterior compartment prolapse: comparison with upright voiding cystourethrogram. Eur J Radiol. 2019;117:95–101.

    Article  PubMed  Google Scholar 

  9. Poncelet E, Rock A, Quinton JF, Cosson M, Ramdane N, Nicolas L, Feldmann A, Salleron J. Dynamic MR defecography of the posterior compartment: comparison with conventional X-ray defecography. Diagn Interv Imaging. 2017;98:327–32.

    Article  CAS  PubMed  Google Scholar 

  10. van Iersel JJ, Formijne Jonkers HA, Verheijen PM, Broeders IAMJ, Heggelman BGF, Sreetharan V, Fütterer JJ, Somers I, van der Leest M, Consten ECJ. Comparison of dynamic magnetic resonance defaecography with rectal contrast and conventional defaecography for posterior pelvic floor compartment prolapse. Color Dis. 2017;19:O46–53.

    Article  Google Scholar 

  11. Foti PV, Farina R, Riva G, Coronella M, Fisichella E, Palmucci S, Racalbuto A, Politi G, Ettorre GC. Pelvic floor imaging: comparison between magnetic resonance imaging and conventional defecography in studying outlet obstruction syndrome. Radiol Med. 2013;118:23–39.

    Article  CAS  PubMed  Google Scholar 

  12. Pannu HK, Scatarige JC, Eng J. Comparison of supine magnetic resonance imaging with and without rectal contrast to fluoroscopic cystocolpoproctography for the diagnosis of pelvic organ prolapse. J Comput Assist Tomogr. 2009;33:125–30.

    Article  PubMed  Google Scholar 

  13. Flusberg M, Sahni VA, Erturk SM, Mortele KJ. Dynamic MR defecography: assessment of the usefulness of the defecation phase. AJR Am J Roentgenol. 2011;196:W394–9.

    Article  PubMed  Google Scholar 

  14. Khatri G, Kumar NM, Xi Y, Smith W, Bacsu C, Bailey AA, Zimmern PE, Pedrosa I. Defecation versus pre- and post-defecation Valsalva maneuvers for dynamic MR assessment of pelvic floor dysfunction. Abdom Radiol (NY). 2021;46:1362–72. https://doi.org/10.1007/s00261-019-02208-8.

    Article  Google Scholar 

  15. Arif-Tiwari H, Twiss CO, Lin FC, Funk JT, Vedantham S, Martin DR, Kalb BT. Improved detection of pelvic organ prolapse: comparative utility of defecography phase sequence to nondefecography valsalva maneuvers in dynamic pelvic floor magnetic resonance imaging. Curr Probl Diagn Radiol. 2019;48:342–7.

    Article  PubMed  Google Scholar 

  16. Bhan SN, Mnatzakanian GN, Nisenbaum R, Lee AB, Colak E. MRI for pelvic floor dysfunction: can the strain phase be eliminated? Abdom Radiol (NY). 2016;41:215–20.

    Article  Google Scholar 

  17. Khatri G, Bailey AA, Bacsu C, Christie AL, Kumar N, Pedrosa I, Zimmern P. Influence of rectal gel volume on defecation during dynamic pelvic floor magnetic resonance imaging. Clin Imaging. 2015;39:1027–31.

    Article  PubMed  Google Scholar 

  18. Bitti GT, Argiolas GM, Ballicu N, Caddeo E, Cecconi M, Demurtas G, Matta G, Peltz MT, Secci S, Siotto P. Pelvic floor failure: MR imaging evaluation of anatomic and functional abnormalities. Radiographics. 2014;34:429–48.

    Article  PubMed  Google Scholar 

  19. Salvador JC, Coutinho MP, Venâncio JM, Viamonte B. Dynamic magnetic resonance imaging of the female pelvic floor–a pictorial review. Insights Imaging. 2019;10:4.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Hassan HH, Elnekiedy AM, Elshazly WG, Naguib NN. Modified MR defecography without rectal filling in obstructed defecation syndrome: initial experience. Eur J Radiol. 2016;85:1673–81.

    Article  PubMed  Google Scholar 

  21. Tumbarello JA, Hsu Y, Lewicky-Gaupp C, Rohrer S, DeLancey JO. Do repetitive Valsalva maneuvers change maximum prolapse on dynamic MRI? Int Urogynecol J. 2010;21:1247–51.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Broekhuis SR, Kluivers KB, Hendriks JC, Vierhout ME, Barentsz JO, Fütterer JJ. Dynamic magnetic resonance imaging: reliability of anatomical landmarks and reference lines used to assess pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20:141–8.

    Article  PubMed  Google Scholar 

  23. Yang A, Mostwin JL, Rosenshein NB, Zerhouni EA. Pelvic floor descent in women: dynamic evaluation with fast MR imaging and cinematic display. Radiology. 1991;179:25–33.

    Article  CAS  PubMed  Google Scholar 

  24. Lienemann A, Sprenger D, Janssen U, Grosch E, Pellengahr C, Anthuber C. Assessment of pelvic organ descent by use of functional cine-MRI: which reference line should be used? Neurourol Urodyn. 2004;23:33–7.

    Article  PubMed  Google Scholar 

  25. Rosenkrantz AB, Lewis MT, Yalamanchili S, Lim RP, Wong S, Bennett GL. Prevalence of pelvic organ prolapse detected at dynamic MRI in women without history of pelvic floor dysfunction: comparison of two reference lines. Clin Radiol. 2014;69:e71–7.

    Article  CAS  PubMed  Google Scholar 

  26. Bremmer S, Mellgren A, Holmström B, López A, Udén R. Peritoneocele: visualization with defecography and peritoneography performed simultaneously. Radiology. 1997;202:373–7.

    Article  CAS  PubMed  Google Scholar 

  27. Lin FC, Funk JT, Tiwari HA, Kalb BT, Twiss CO. Dynamic pelvic magnetic resonance imaging evaluation of pelvic organ prolapse compared to physical examination findings. Urology. 2018;119:49–54.

    Article  PubMed  Google Scholar 

  28. Cronjé HS, de Beer JA. Culdocele repair in female pelvic organ prolapse. Int J Gynaecol Obstet. 2008;100:262–6.

    Article  PubMed  Google Scholar 

  29. Wallace SL, Torosis M, Rogo-Gupta L. Does rectocele on defecography equate to rectocele on physical examination in patients with defecatory symptoms? Female Pelvic Med Reconstr Surg. 2021;27:18–22.

    Article  PubMed  Google Scholar 

  30. Hall GM, Shanmugan S, Nobel T, et al. Symptomatic rectocele: what are the indications for repair? Am J Surg. 2014;207:375–9.

    Article  PubMed  Google Scholar 

  31. Bordeianou L, Hicks CW, Kaiser AM, Alavi K, Sudan R, Wise PE. Rectal prolapse: an overview of clinical features, diagnosis, and patient-specific management strategies. J Gastrointest Surg. 2014;18:1059–69.

    Article  PubMed  Google Scholar 

  32. Cavallaro PM, Staller K, Savitt LR, Milch H, Kennedy K, Weinstein MM, Ricciardi R, Bordeianou LG. The contributions of internal intussusception, irritable bowel syndrome, and pelvic floor dyssynergia to obstructed defecation syndrome. Dis Colon Rectum. 2019;62:56–62.

    Article  PubMed  Google Scholar 

  33. Blaker K, Anandam JL. Functional disorders: rectoanal intussusception. Clin Colon Rectal Surg. 2017;30:5–11.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Wijffels NA, Jones OM, Cunningham C, Bemelman WA, Lindsey I. What are the symptoms of internal rectal prolapse? Color Dis. 2013;15:368–73.

    Article  CAS  Google Scholar 

  35. Bordeianou L, Savitt L, Dursun A. Measurements of pelvic floor dyssynergia: which test result matters? Dis Colon Rectum. 2011;54:60–5.

    Article  PubMed  Google Scholar 

  36. Rao SS, Bharucha AE, Chiarioni G, et al. Functional anorectal disorders. Gastroenterology. 2016;150:1430–1442.E4. https://doi.org/10.1053/j.gastro.2016.02.009.

    Article  Google Scholar 

  37. Rao SS, Benninga MA, Bharucha AE, Chiarioni G, Di Lorenzo C, Whitehead WE. ANMS-ESNM position paper and consensus guidelines on biofeedback therapy for anorectal disorders. Neurogastroenterol Motil. 2015;27:594–609.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Seong MK, Kim TW. Significance of defecographic parameters in diagnosing pelvic floor dyssynergia. J Korean Surg Soc. 2013;84:225–30.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Carrington EV, Scott SM, Bharucha A, et al. International Anorectal Physiology Working Group and the International Working Group for Disorders of Gastrointestinal Motility and Function Expert consensus document: advances in the evaluation of anorectal function. Nat Rev Gastroenterol Hepatol. 2018;15:309–23.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Grossi U, Di Tanna GL, Heinrich H, Taylor SA, Knowles CH, Scott SM. Systematic review with meta-analysis: defecography should be a first-line diagnostic modality in patients with refractory constipation. Aliment Pharmacol Ther. 2018;48:1186–201.

    Article  PubMed  Google Scholar 

  41. Tirumanisetty P, Prichard D, Fletcher JG, Chakraborty S, Zinsmeister AR, Bharucha AE. Normal values for assessment of anal sphincter morphology, anorectal motion, and pelvic organ prolapse with MRI in healthy women. Neurogastroenterol Motil. 2018;30:e13314.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Funding/support

None reported.

Author information

Author notes

  1. Brooke H. Gurland, Gaurav Khatri, and Roopa Ram contributed equally to this work (first co-authors and chairs of the MRI working group).

Authors and Affiliations

  1. Division of Colorectal Surgery, Stanford University, Palo Alto, CA, USA

    Brooke H. Gurland

  2. Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Gaurav Khatri

  3. Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Roopa Ram & Kedar R. Jambhekar

  4. Department of Colorectal Surgery, Cleveland Clinic Hospitals, Cleveland, OH, USA

    Tracy L. Hull

  5. Department of Urology, College of Medicine University of Illinois, Chicago, IL, USA

    Ervin Kocjancic

  6. Department of Obstetrics & Gynecology, University of Oklahoma, Oklahoma City, Ok, USA

    Lieschen H. Quiroz

  7. Department of Radiology, Cairo University Pelvic Floor Centre of Excellency and Research Lab, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt

    Rania F. El Sayed

  8. Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, The Bronx, NY, USA

    Victoria Chernyak

  9. Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Raj Mohan Paspulati

  10. Department of Radiology, Stanford University, Palo Alto, CA, USA

    Vipul R. Sheth

  11. Department of Radiology, Mount Sinai South Nassau Hospital, Oceanside, NY, USA

    Ari M. Steiner

  12. Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Amita Kamath

  13. Department of Obstetrics & Gynecology, University of Virginia, INOVA Women’s Hospital, Falls Church, VA, USA

    S. Abbas Shobeiri

  14. Department of Obstetrics & Gynecology, Massachusetts General Hospital Pelvic Floor Disorders Center, Harvard Medical School, Boston, MA, USA

    Milena M. Weinstein

  15. Department of Gastrointestinal Surgery, Massachusetts General Hospital Pelvic Floor Disorders Center, Harvard Medical School, Boston, MA, USA

    Liliana Bordeianou

  16. Massachusetts General Hospital Surgery, 55 Fruit St, GRB 425, Boston, MA, 02114, USA

    Liliana Bordeianou

Authors
  1. Brooke H. Gurland
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gaurav Khatri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roopa Ram
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tracy L. Hull
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ervin Kocjancic
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lieschen H. Quiroz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rania F. El Sayed
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kedar R. Jambhekar
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Victoria Chernyak
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Raj Mohan Paspulati
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Vipul R. Sheth
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Ari M. Steiner
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Amita Kamath
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. S. Abbas Shobeiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Milena M. Weinstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Liliana Bordeianou
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

On Behalf of the Members of the Expert Workgroup on Magnetic Resonance Imaging of Pelvic Floor Disorders

  • Jennifer Ayscue
  • , Pedro Basilio
  • , Cynthia Hall
  • , Karin Herrmann
  • , Andreas M Kaiser
  • , Khashayar Rafatzand
  • , Luz Maria Rodriguez
  • , Kavita Mishra
  • , Leila Neshatian
  • , Erin O’Neill
  • , Albert Parlade
  • , Raveen Syan
  •  & Amber Traugott

Corresponding author

Correspondence to Liliana Bordeianou.

Ethics declarations

Conflict of interest

None reported.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Members of the Expert Workgroup on Magnetic Resonance Imaging of Pelvic Floor Disorders are listed in alphabetical order in Table 1.

Endorsement This consensus has been endorsed by all 6 supporting societies.

Citation This article is being published concurrently in Diseases of the Colon & Rectum, American Journal of Roentgenology, International Urogynecological Journal, and Female Pelvic Medicine and Reconstructive Surgery Journal. The articles are identical except for minor stylistic and spelling differences in keeping with each journal’s style. Citation from any of the 4 journals can be used when citing this article.

Supplementary Information

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.dcrjournal.com).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gurland, B.H., Khatri, G., Ram, R. et al. Consensus definitions and interpretation templates for magnetic resonance imaging of Defecatory pelvic floor disorders. Int Urogynecol J 32, 2561–2574 (2021). https://doi.org/10.1007/s00192-021-04955-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-021-04955-z

Keywords

Search

Navigation