Advances in MRI assessment of pelvic floor structure and function: a review

Abstract

•. Advances in pelvic MRI techniques are enabling better appreciation of the complexity of pelvic floor disorders. •. Static and dynamic imaging is useful to depict the range of pelvic floor pathology. •. Clinical demand for comprehensive MRI is increasing because of its non-invasive dynamic nature that is able to provide anatomical and functional information relevant to urogynaecologists and surgeons. •. Imaging findings still need to be carefully correlated to the clinical scenario and physiology. MRI is now an established technique for the evaluation of pelvic floor structure and function. As a non-ionising modality it allows a large field of view for the dynamic evaluation of all pelvic organs in multiple planes with high soft-tissue and temporal resolution. Both static and dynamic protocols may be followed including the use of proctography. Difficulties with evacuation and prolapse can be accurately depicted and aid guide physicians, urogynaecologists and surgeons in management. A thorough understanding of pelvic floor anatomy is required for interpretation, and this review enables the radiologist to correlate patterns of prolapse and pelvic injury with anatomical stucture. Grading of prolapse with reference to the pubococcygeal line is utilized. Illustrated examples include cystocoele, peritoneocele, enterocele, rectocele and intussusception. A description of spastic pelvic floor syndrome is also included. As pelvic floor disorders require close correlation to the clinical features and physiology, it is important not to interpret imaging findings in isolation, and a multidisciplinary approach is therefore adopted.