Advertisement

How to Perform and Report Magnetic Resonance Imaging for Pelvic Floor Dysfunction: An Interactive Case-Based Approach

  • Rania Farouk El Sayed

Abstract

‘You look for what you know, and you see what you are looking for.’

This statement summarizes all concepts a radiologist must understand to provide the gold standard of care. My fundamental aim in teaching this course is not just to review the literature with participants but to teach vividly, interactively, and practically, which is the way students learn best. It is my belief that if this course is successful, every radiologist in attendance will be capable not only of writing a full report based on solid scientific information but also of providing state-of-the art care for patients who present for magnetic resonance imaging (MRI) for pelvic floor dysfunction (PFD). Full competence means that the radiologist will know the steps for taking a full relevant medical history, can confidently determine which radiologic studies to order to allow for a detailed diagnostic report, and know the mandatory steps for patient preparation before sending the patient to the imaging table. In this context, this review is not written in the classical chronological order but in a way that takes the reader through the actual sequence of steps for providing radiologic care for a patient with PFD.

Keywords

Pelvic Floor Stress Urinary Incontinence Pelvic Organ Prolapse Anal Sphincter Pelvic Floor Muscle 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Maglinte DDT, Kelvin PM, Fitzgerald K et al (1999) Association of compartments defects in pelvic floor dysfunction. AJR Am J Roentgenol 172:439–444.PubMedCrossRefGoogle Scholar
  2. 2.
    El Sayed RF, Mashed SE, Farag A et al (2008) Pelvic floor dysfunction: assessment with combined analysis of static and dynamic MR imaging findings. Radiology 248:518–530.PubMedCrossRefGoogle Scholar
  3. 3.
    Woodfield CA, Krishnamoorthy S, Hampton BS, Brody JM (2010) Imaging pelvic floor disorders: trend toward comprehensive MRI. AJR Am J Roentgenol 194:1640–1649.PubMedCrossRefGoogle Scholar
  4. 4.
    El Sayed RF, Morsy MM, El Mashed SM, Abdul-Azim MS (2007) Anatomy of the urethral supporting ligaments defined by dissection, histology, and MRI of female cadavers and MRI of healthy nulliparous women. AJR Am J Roentgenol 189:1145–1157.PubMedCrossRefGoogle Scholar
  5. 5.
    Strohbehn K (1998) Normal pelvic floor anatomy. Obstet Gynecol Clin North Am 25:683–705.PubMedCrossRefGoogle Scholar
  6. 6.
    DeLancey JO (1994) The anatomy of pelvic floor. Curr Opin Obstet Gynecol 6:313–316.PubMedCrossRefGoogle Scholar
  7. 7.
    Petros PEP (2007) Overview. In: Petros PEP (ed) The female pelvic floor. Function, dysfunction and management according to the integral theory, 2nd edition. Springer, Berlin, pp 3–4.Google Scholar
  8. 8.
    El Sayed Rf (2013) The urogynecological side of pelvic floor MRI: the clinician’s needs and the radiologist’s role. Abdom Imaging 38:912–929.CrossRefGoogle Scholar
  9. 9.
    Abrams P, Cardozo L, Fall M et al (2002) The standardisation of terminology of lower urinary tract function: report from the standardization sub-committee of the international continence society. Neurourol Urodyn 21:167–178.PubMedCrossRefGoogle Scholar
  10. 10.
    Fultz NH, Burgio K, Diokno AC et al (2003) Burden of stress urinary incontinence for community-dwelling women. Am J Obstet Gynecol 189:1275–1282.PubMedCrossRefGoogle Scholar
  11. 11.
    Hannestad YS, Rortveit G, Sandvik H, Hunskaar S (2000) A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. Epidemiology of Incontinence in the County of Nord-Trøndelag. J Clin Epidemiol 53:1150–1157.PubMedCrossRefGoogle Scholar
  12. 12.
    El Sayed RF (2009) Female pelvic floor dysfunction. In: Morcos SK, Thomsen HS (Eds) Imaging in genitourinary medicine: a problem-oriented approach. Wiley-Blackwell, Chichester, pp 399–413.CrossRefGoogle Scholar
  13. 13.
    Yang A, Mostwin JL, Rosenshein NB, Zerhouni EA (1991) Pelvic floor descent in women: dynamic evaluation with fast MR imaging and cinematic display. Radiology 179:25–33.PubMedCrossRefGoogle Scholar
  14. 14.
    Mengert WF (1936) Mechanics of uterine support and position. Am J Obstet Gynecol 31:775–782.Google Scholar
  15. 15.
    DeLancey JO (1993) Anatomy and biomechanics of genital prolapse. Clin Obstet Gynecol 36:897–909.PubMedCrossRefGoogle Scholar
  16. 16.
    DeLancey JO (2003) Functional anatomy of the pelvic floor. In: Bartram CI, DeLancey JO, Halligan S et al (Eds) Imaging pelvic floor disorders. Springer, New York, pp 27–38.CrossRefGoogle Scholar
  17. 17.
    El Sayed RF, Fielding JR, El Mashed S et al (2005) Preoperative and postoperative magnetic resonance imaging of female pelvicfloor dysfunction: correlation with clinical findings. J Women’s Imaging 7:163–180.CrossRefGoogle Scholar
  18. 18.
    Kelvin FM, Pannu HK (2003) Dynamic cystoproctography: fluoroscopic and MR techniques for evaluating pelvic organ prolapse. In: Bartram CI, DeLancey JO, Halligan S et al (Eds) Imaging pelvic floor disorders. Springer, New York, pp 51–56.Google Scholar
  19. 19.
    Goh V, Halligan S, Kaplan G et al (2000) Dynamic MRI of the pelvic floor in asymptomatic subjects. AJR Am J Roentgenol 174:661–666.PubMedCrossRefGoogle Scholar
  20. 20.
    Lienemann A, Anthuber C, Baron A et al (1997) Dynamic MR colpocystorectography assessing pelvic floor descent. Eur Radiol 7:1309–1317.PubMedCrossRefGoogle Scholar
  21. 21.
    Goh V, Halligan S, Kaplan G et al (2000) Dynamic MRI of the pelvic floor in asymptomatic subjects. AJR Am J Roentgenol 174:661–666.PubMedCrossRefGoogle Scholar
  22. 22.
    Comiter CV, Vasavada SF, Barbaric ZL et al (1999) Grading pelvic prolapse and pelvic floor relaxation using dynamic magnetic resonance imaging. Urology 3:454–457.CrossRefGoogle Scholar
  23. 23.
    Fielding JR (2002) Practical MR imaging of female pelvic floor weakness. Radiographics 22:295–304.PubMedCrossRefGoogle Scholar
  24. 24.
    Huddleston HT, Dunnihoo DR, Huddleston PM, Meyers PC (1995) Magnetic resonance imaging of defects in DeLancey’s vaginal support levels I, II, and III. Am J Obstet Gynecol 172: 1778–1784.PubMedCrossRefGoogle Scholar
  25. 25.
    Klutke CG, Siegel CL (1995) Functional female pelvic anatomy. Urol Clin N Am 22:487–498.Google Scholar
  26. 26.
    McCarthy TA (1991) Medical history and physical examination. In: Ostergard DR, Bent AE (Eds) Urogynecology and urodynamics theory and practice, 3rd edition. Williams & Wilkins, Baltimore, pp 99–101.Google Scholar

Copyright information

© Springer-Verlag Italia 2014

Authors and Affiliations

  • Rania Farouk El Sayed
    • 1
  1. 1.Radiology DepartmentCairo UniversityCairoEgypt

Personalised recommendations