PD29-06 ADDITION OF A DEFECOGRAPHY PHASE TO DYNAMIC PELVIC MRI ENHANCES DETECTION AND VISUALIZATION OF PELVIC ORGAN PROLAPSE

Abstract

INTRODUCTION AND OBJECTIVES: Dynamic Pelvic MRI (DPMRI) remains an emerging diagnostic modality in the evaluation of Pelvic Organ Prolapse (POP), but study quality remains variable, and is typically dependent upon performance of a proper valsalva maneuver during the dynamic phase of the procedure. We sought to determine whether the addition of a defecography phase (DP) to routine DPMRI would increase its clinical utility over standard valsalva maneuver (VM) in the evaluation of POP. METHODS: Fifty-six female patients undergoing preoperative evaluation for surgical correction of symptomatic POP were evaluated by DPMRI utilizing a protocol incorporating both VM and DP. Ultrasound gel was injected into the vagina and rectum followed by (1) steady state free precession images in the sagittal plane, (2) dynamic cine acquisitions during VM, and (3) dynamic cine acquisitions during DP. All images were separately reviewed in a blinded fashion by two radiologists experienced in DPMRI. The HMO system was used for quantification of pelvic floor descent. Inferior descent of the ano-rectal junction, bladder base and vaginal vault was recorded in all patients, utilizing the pubococcygeal line (PCL) as a fixed landmark. IRB approval was obtained for the study. RESULTS: DP produced a greater degree of pelvic organ descent compared to VM for all recorded measures in all 56 patients. 100%(56/56) demonstrated rectocele, 71% (40/56) cystocele and 71% (40/56) vaginal vault descent on DP, compared with 86% (48/56), 14% (8/56) and 43% (24/56) on VM, respectively. The average descent of the bladder base was 3.4 cm with DP, compared to 0.4 cm with VM (p<0.01). Average descent of the vaginal vault was 5.1 cm with DP, compared to 3.5 cm with VM (p<0.01). Average rectal descent was 5.5cm with DP, compared to 4.6cm with VM (p<0.01). CONCLUSIONS: DPMRI utilizing a defecography phase demonstrates pelvic organ prolapse better than DPMRI utilizing valsalva maneuver alone. Pelvic organs may show mild prolapse or even appear normal with valsalva maneuver alone, but may demonstrate marked prolapse during the defecography phase.