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MRI of the Pelvic Floor

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MRI and CT of the Female Pelvis

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

Abstract

Pelvic floor dysfunction comprises disorders related to pelvic floor descent and pelvic organ prolapse, urinary and fecal incontinence, defecation disorders, or pelvic pain. Although it may also occur in young age, typically postmenopausal women suffer from pelvic floor dysfunction that may significantly impair the quality of life. Its etiology is multifactorial, but female gender, increasing age and childbirths have been recognized as leading risk factors. MRI has emerged as an imaging technique to provide comprehensive information and has become an important diagnostic tool for treatment planning and for tailoring the surgical approach in pelvic floor pathologies.

This chapter reviews MRI for evaluation of the pelvic floor. The first part focuses on details of the examination technique, and provides information to assess qualitatively and quantitatively the pelvic floor. In the second part typical imaging findings associated with pathologies within the three anatomical compartments of the pelvic floor are covered. Finally, strengths and limitations of MRI of the pelvic floor will be discussed.

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Abbreviations

MRI:

Magnetic resonance imaging

PCL:

Pubococcygeal line

POP:

Pelvic organ prolapse

US:

Ultrasonography

WI:

Weighted images

References

  • Alt CD, Brocker KA, Lenz F, Sohn C, Kauczor HU, Hallscheidt P (2014) MRI findings before and after prolapse surgery. Acta Radiol 55:495–504

    Article  Google Scholar 

  • Bazot M, Gasner A, Ballester M, Daraï E (2011) Value of thin-section oblique axial T2-weighted magnetic resonance images to assess uterosacral ligament endometriosis. Hum Reprod 26:346–5350

    Article  Google Scholar 

  • Bertschinger KM, Hetzer FH, Roos JE et al (2002) Dynamic MR imaging of the pelvic floor performed with patient sitting in an open-magnet unit versus with patient supine in a closed-magnet unit. Radiology 223:501–508

    Article  Google Scholar 

  • Bitti GT, Argiolas GM, Ballicu N, Caddeo E et al (2014) Pelvic floor failure: MR imaing evaluation of anatomic and functional abnormalities. Radiographics 34:429–448

    Article  Google Scholar 

  • Bo K, Lilleas F, Talseth T et al (2001) Dynamic MRI of the pelvic floor muscles in an upright sitting position. NeurourolUrodyn 20:167–174

    CAS  Google Scholar 

  • Bolog N, Weishaupt D (2005) Dynamic MR imaging of putlet obstruction. Clin Imaging 14:293–302

    Google Scholar 

  • Bump RC, Mattiasson A, Bo K et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175:10–17

    Article  CAS  Google Scholar 

  • Carr LK, Herschorn S, Leonhardt C (1996) Magnetic resonance imaging after intraurethral collagen injected for stress urinary incontinence. J Urol 155:1253–1255

    Article  CAS  Google Scholar 

  • Comiter CV, Vasavada SP, Barbaric ZL et al (1999) Grading pelvic prolapse and pelvic floor relaxation using dynamic magnetic resonance imaging. Urology 54:454–454

    Article  CAS  Google Scholar 

  • Delemarre JB, Kruyt RH, Doornbos J et al (1994) Anterior rectocele: assessment with radiographic defecography, dynamic magnetic resonance imaging, and physical examination. Dis Colon Rectum 37:249–259

    Article  CAS  Google Scholar 

  • Dietz HP (2010) Pelvic floor ultrasound: a review. Am J Obstet Gynecol 202:321–334

    Article  Google Scholar 

  • El Sayed R, MSE FMMM, Azim MSA (2008) Pelvic floor dysfunction: assessment with combined analysis of static and dynamic MR imagin g findings. Radiology 248:518–530

    Article  Google Scholar 

  • El Sayed RF, Alt CD, Maccioni F et al (2016) Magnetic Resonance Imaging of pelvic floor dysfunction-joint recommendations of the ESUR and ESGAR pelvic floor working group. Eur Radiol. doi:10.1007/s00330-016-4471-

    Article  PubMed  PubMed Central  Google Scholar 

  • Elshazly WG, Nekady AEE, Hassan H (2010) Role of dynamic MRI in management of obstructed defecation case series. Int J Surg 8:2074–2282

    Article  Google Scholar 

  • Faccioli N, Comai A, Mainardi P, Perandini S, Farah M, Pozzi-Mucelli R (2010) Defecography: a practical approach. Diagn Interv Radiol 16:209–216

    PubMed  Google Scholar 

  • Fielding JR (2002) Practical MR imaging of female pelvic floor weakness. Radiographics 22:295–304

    Article  Google Scholar 

  • Fielding JR (2003) MR imaging of pelvic floor relaxation. Radiol Clin North Am 41:747–756

    Article  Google Scholar 

  • Fielding JR, Griffiths DJ, Versi E et al (1998) MR imaging of pelvic floor continence mechanisms in the supine and sitting positions. AJR Am J Roentgenol 171:1607–1610

    Article  CAS  Google Scholar 

  • Flusberg M, Sahni VA, Erturk SM, Mortele KJ (2011) Dynamic MR defecography: assessment of the usefulness of the defecation phase. AJR Am J Roentgenol 196:W394–W399

    Article  Google Scholar 

  • Goei R, Kemerink G (1990) Radiation dose in defecography. Radiology 176:137–139

    Article  CAS  Google Scholar 

  • Goh V, Halligan S, Kaplan G et al (2000) Dynamic MR imaging of the pelvic floor in asymptomatic subjects. AJR Am J Roentgenol 174:661–666

    Article  CAS  Google Scholar 

  • Goodrich MA, Webb MJ, King BF et al (1993) Magnetic resonance imaging of pelvic floor relaxation: dynamic analysis and evaluation of patients before and after surgical repair. Obstet Gynecol 82:883–891

    CAS  PubMed  Google Scholar 

  • Gufler H, Laubenberger J, DeGregorio G et al (1999) Pelvic floor descent: dynamic MR imaging using a half-Fourier RARE sequence. J Magn Reson Imaging 9:378–383

    Article  CAS  Google Scholar 

  • Gufler H, Ohde A, Grau G et al (2004) Colpocystoproctography in the upright and supine positions correlated with dynamic MRI of the pelvic floor. Eur J Radiol 51:41–47

    Article  Google Scholar 

  • Halligan S, Bartram C, Hall C, Wingate J (1996) Enterocele revealed by simultaneous evacuation proctography and peritoneography: does “defecation block” exist? Am J Roentgenol 167:461–466

    Article  CAS  Google Scholar 

  • Halligan S, Malouf A, Batram CI, Marshall M, Hollings N, Kamm MA (2001) Predictive value of impaired evacuation at proctopgraphy in diagnosing anismus. AJR Am J Roentgenol 177:633–636

    Article  CAS  Google Scholar 

  • Handa V, Pannu H, Siddique S et al (2003) Architectural differences in the bony pelvis of women with and without pelvic floor disorders. Obstet Gynecol 102:1283–1290

    PubMed  Google Scholar 

  • Healy JC, Halligan S, Reznek RH et al (1997a) Dynamic MR imaging compared with evacuation proctography when evaluating anorectal configuration and pelvic floor movement. AJR Am J Roentgenol 169:775–779

    Article  CAS  Google Scholar 

  • Healy JC, Halligan S, Reznek RH et al (1997b) Magnetic resonance imaging of the pelvic floor in patients with obstructed defaecation. Br J Surg 84:1555–1558

    Article  CAS  Google Scholar 

  • Hjartardottir S, Nilsson J, Petersen C et al (1997) The female pelvic floor: a dome – not a basin. Acta Obstet Gynecol Scand 76:567–571

    Article  CAS  Google Scholar 

  • Hodroff MA, Stolpen AH, Denson MA et al (2002) Dynamic magnetic resonance imaging of the female pelvis: the relationship with the pelvic organ prolapse quantification staging system. J Urol 167:1353–1355

    Article  Google Scholar 

  • Hoyte L, Ratiu P (2001) Linear measurements in 2-dimensional pelvic floor imaging: the impact of slice tilt angles on measurement reproducibility. Am J Obstet Gynecol 185:537–544

    Article  CAS  Google Scholar 

  • Huddleston HT, Dunnihoo DR, Huddleston PM 3rd et al (1995) Magnetic resonance imaging of defects in DeLancey’s vaginal support levels I, II, and III. Am J Obstet Gynecol 172:1778–1782; discussion 1782–1784

    Article  CAS  Google Scholar 

  • van Iersel JJ, Formijne Jonkers HA, Verheijen PM, Broeders IAMJ, Heggelman BG et al (2017) Comparison of dynamic magnetic resonance defaecography with rectal contrast and conventional defaecography for posterior pelvic floor compartment prolapse. Colorectal Dis 19:O46–O53. doi:10.1111/codi.13563

    Article  PubMed  Google Scholar 

  • Jundt K, Peschers U, Kentenich H (2015) The investigation and treatment of female pelvic floor dysfunction. Dtsch Arztebl Int 112:564–574

    PubMed  PubMed Central  Google Scholar 

  • Kelvin FM, Maglinte DD, Hale DS et al (2000) Female pelvic organ prolapse: a comparison of triphasic dynamic MR imaging and triphasic fluoroscopic cystocolpoproctography. AJR Am J Roentgenol 174:81–88

    Article  CAS  Google Scholar 

  • Kenton K, Mueller ER (2006) The global burden of female pelvic flor disorders. BJU Int 98(Suppl 1):1–5

    Article  Google Scholar 

  • Kim AY (2011) How to interpret a functional or motility test-defecography. J Neurogastroenterol Motil 17:416–420

    Article  Google Scholar 

  • vKruyt RH, Delemarre JB, Doornbos J et al (1991) Normal anorectum: dynamic MR imaging anatomy. Radiology 179:159–163

    Article  Google Scholar 

  • Kuhn RJ, Hollyock VE (1982) Observations on the anatomy of the rectovaginal pouch and septum. Obstet Gynecol 59:445–447

    CAS  PubMed  Google Scholar 

  • Law YM, Fielding JR (2008) MRI of pelvic floor dysfunction: review. AJR Am J Roentgenol 191:S45–S53

    Article  Google Scholar 

  • Lienemann A (1998) An easy approach to functional magnetic resonance imaging of pelvic floor disorders. Tech Coloproctol 2:131–134

    Google Scholar 

  • Lienemann A, Anthuber C, Baron A et al (1996) MR colpocystorectography: a new dynamic method for assessing pelvic floor descent and prolapse in women. Acta Radiol 6:182–186

    CAS  Google Scholar 

  • Lienemann A, Anthuber C, Baron A et al (1997) Dynamic MR colpocystorectography assessing pelvic-floor descent. Eur Radiol 7:1309–1317

    Article  CAS  Google Scholar 

  • Lienemann A, Sprenger D, Janssen U et al (2000a) Functional MRI of the pelvic floor. The methods and reference values. Radiologe 40:458–464

    Article  CAS  Google Scholar 

  • Lienemann A, Anthuber C, Baron A et al (2000b) Diagnosing enteroceles using dynamic magnetic resonance imaging. Dis Colon Rectum 43:205–212; discussion 212–213

    Article  CAS  Google Scholar 

  • Lone F, Sultan AH, Stankiewicz A, Thakar R (2016) Interobserver agreement of multicompartment ultrasound in the assessment of pelvic floor anatomy. Br J Radiol. doi:10.1259/bjr.20150704. Epub 2016 Jan 22

    Article  PubMed  PubMed Central  Google Scholar 

  • Macura KJ, Genadry RR, Bluemeke DA (2006) MR imaging of the female urethra and supporting ligaments in assessment of urinary incontinence: spectrum of abnormalities. Radiographics 26:1135–1149

    Article  Google Scholar 

  • Maglinte DD, Bartram CI, Hale DA, Park J, Kohli MD, Robb BW, Romano S, Lappas JC (2011) Functional imaging of the pelvic floor. Radiology 258:23–39

    Article  Google Scholar 

  • Maigne JY, Pigeau I, Roger B (2012) Magnetic resonance imaging findings in the painful adult coccyx. Eur Spine J 21:2097–2104

    Article  Google Scholar 

  • Mann DKP (2014) What is clinically relevant prolapse? An attempt at defining cutoffs for the assessment of pelvcic organ prolapse. Int Urogynecol 25:451–455

    Article  Google Scholar 

  • Mortele KJ (2007) Dynamic MR defecography of the posterior compartment: indications, techniques and MR features. Eur J Radiol 61(2007):462–472

    Article  Google Scholar 

  • Pannu HK, Kaufman HS, Cundiff GW et al (2000) Dynamic MR imaging of pelvic organ prolapse: spectrum of abnormalities. Radiographics 20:1567–1582

    Article  CAS  Google Scholar 

  • Pannu HC, Glanc P, Bhosale PR, Harisinghani MG et al (2015) ACR appropriateness criteris pelvic floor dysfunction. J Am Coll Radiol 12:134–142

    Article  Google Scholar 

  • Pizzoferrato AC, Nyangoh Timoh K, Fritel X, Zareski E (2014) Dynamic Magnetic Resonance Imaging and pelvic floor disorders: how and when? Eur J Obstet Gynecol Reprod Biol 181:259–266

    Article  Google Scholar 

  • Reiner CS, Tutuian R, Pohl D, Marincek B, Weishaupt D (2011) MR defecography in patients with dysynergetic defecation:spectrum of imaing findings and diagnstic value. Br J Radiol 84:136–144

    Article  CAS  Google Scholar 

  • Retzky SS, Rogers jr RM, Richardson AC (1996) Anatomy of female pelvic support. In: Brubaker LT, Saclarides TJ (eds) The female pelvic floor disorders of function and support. F.A. Davis Company, Philadelphia, pp 3–21

    Google Scholar 

  • Rogers RG, Fashokun TB (2016) Pelvic organ prolapse in women: an overview of the epidemiology, risk factors, clinical manifestations, and management. www.uptodate.com

  • Schreyer CA, Paetzel C, Fürst A et al (2012) Dynamic MR defecography in 10 asymptomatic volunteers. World J Gastroenterol 18:6836–6842

    Article  Google Scholar 

  • Shorvon PJ, McHugh S, Diamant NE et al (1989) Defecography in normal volunteers: results and implications. Gut 30:1737–1717

    Article  CAS  Google Scholar 

  • Singh K, Reid WM, Berger LA (2001) Assessment and grading of pelvic organ prolapsed by use of dynamic resonance imaging. Am J Obstet Gynecol 185:71–77

    Article  CAS  Google Scholar 

  • Singh K, Reid WM, Berger LA (2002) Magnetic resonance imaging of normal levator ani anatomy and function. Obstet Gynecol 99:433–438

    PubMed  Google Scholar 

  • Sprenger D, Lienemann A, Anthuber C et al (2000) Functional MRI of the pelvic floor: its normal anatomy and pathological findings. Radiologe 40:451–457

    Article  CAS  Google Scholar 

  • Swift SE (2000) The distribution of pelvicorgan support in a population of femalesubjects seen for routine gynecologichealth care. Am J Obstet Gynecol 183:277–285

    Article  CAS  Google Scholar 

  • Swift S, Woodman P, O’Boyle A et al (2005) Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol 192:795–806

    Article  Google Scholar 

  • Tijdink MM, Vierhout ME, Heesakkers JP, Withagen MI (2011) Surgical management of mesh related complications after prior pelvic floor reconstructive surgery with mesh. Int Urogynecol J 22:1395–1404

    Article  Google Scholar 

  • Vanbeckevoort D, Van Hoe L, Oyen R et al (1999) Pelvic floor descent in females: comparative study of colpocystodefecography and dynamic fast MR imaging. J Magn Reson Imaging 9:373–377

    Article  CAS  Google Scholar 

  • Woodfield CA, Hampton BS, Sung V, Brody JM (2009) Magnetic resonance imaging of pelvic organ prolapse: comparing pubococcygeal and midpubic lines with clinical staging. Int Urogynecol J Pelvic Floor Dysfunct 20:695–701

    Article  Google Scholar 

  • Woodfield CA, Krisnamoorthy S, Hampton BS, Brody JM (2010) Imaging pelvic floor disorders: trend toward comprehensive MRI. AJR Am J Roentgenol 194:1640–1649

    Article  Google Scholar 

  • Yang A, Mostwin JL, Rosenshein NB et al (1991) Pelvic floor descent in women: dynamic evaluation with fast MR imaging and cinematic display. Radiology 179:25–33

    Article  CAS  Google Scholar 

  • Yoshioka K, Matsui Y, Yamada O et al (1991) Physiologic and anatomic assessment of patients with rectocele. Dis Colon Rectum 34:704–708

    Article  CAS  Google Scholar 

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Correspondence to Rosemarie Forstner .

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Forstner, R., Lienemann, A. (2017). MRI of the Pelvic Floor. In: Forstner, R., Cunha, T.M., Hamm, B. (eds) MRI and CT of the Female Pelvis. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/174_2017_53

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  • DOI: https://doi.org/10.1007/174_2017_53

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