PD02-06 DYNAMIC PELVIC MRI IN THE EVALUATION OF PELVIC ORGAN PROLAPSE AND CORRELATION WITH PHYSICAL EXAM FINDINGS

Abstract

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Pelvic Prolapse I1 Apr 2017PD02-06 DYNAMIC PELVIC MRI IN THE EVALUATION OF PELVIC ORGAN PROLAPSE AND CORRELATION WITH PHYSICAL EXAM FINDINGS Frank C. Lin, Hina A. Tiwari, Bobby T. Kalb, Joel T. Funk, and Christian O. Twiss Frank C. LinFrank C. Lin More articles by this author , Hina A. TiwariHina A. Tiwari More articles by this author , Bobby T. KalbBobby T. Kalb More articles by this author , Joel T. FunkJoel T. Funk More articles by this author , and Christian O. TwissChristian O. Twiss More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.199AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Dynamic Pelvic Floor Magnetic Resonance Imaging (dMRI) provides objective evaluation of pelvic organ prolapse (POP), and few studies have compared physical examination (PE) to dMRI. We present the largest series comparing dMRI with PE findings. METHODS A total of 274 consecutive patients underwent dMRI with defecography, and charts were retrospectively reviewed for Baden-Walker grading of POP (Grade 0-4), absolute dMRI values, and grading by dMRI (Grade 0-3). Exclusion criteria included incomplete PE or dMRI, and males. Clinically significant POP was defined as Baden-Walker (B-W) Grade ≥3 and dMRI Grade ≥2 with clinically insignificant POP defined as B-W Grade 0-1 and dMRI Grade 0. Spearman correlation was performed between absolute dMRI values and POP grade. RESULTS In total, 178 female patients had both PE and dMRI as part of their POP assessment. In the anterior compartment, there was a moderate positive correlation (r=0.652) between dMRI values and PE. PE and dMRI had 90.7% agreement in patients without clinically significant cystocele. Clinically significant cystoceles on PE were read as Grade ≥2 on dMRI in 84.6% of subjects. Correlation between PE and dMRI for apical prolapse was poor (r=0.195). For patients without significant apical prolapse, PE and dMRI had 59.2% agreement. Clinically significant apical prolapse on PE was read as dMRI Grade ≥2 in 62.9% of subjects. However, dMRI detected 30 patients with enterocele with PE agreeing in only 9 patients. Three of these 30 patients (10%) with pure enterocele were misdiagnosed as rectocele on PE. Conversely, PE detected 20 patients with enteroceles with dMRI confirmation in 9 cases. Correlation between PE and dMRI was also poor in the posterior compartment (r=0.277). PE and dMRI had 55.4% agreement in patients without significant posterior prolapse, whereas clinically significant rectoceles were read as dMRI Grade ≥2 in 77.7% of subjects. CONCLUSIONS This is the largest study to date comparing dMRI to PE for the evaluation of POP. dMRI correlated well with PE in the anterior compartment but yielded little additional diagnostic value. Correlation in the posterior compartment was poor, but dMRI tended to agree with PE in higher grades of POP. dMRI was superior to PE in the detection of enterocele and was better able to distinguish enterocele from rectocele. dMRI may add the most diagnostic value in cases where the presence of enterocele is unclear. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e53 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Frank C. Lin More articles by this author Hina A. Tiwari More articles by this author Bobby T. Kalb More articles by this author Joel T. Funk More articles by this author Christian O. Twiss More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...