Role of static and dynamic MRI in evaluation of pelvic posterior compartment pathologies: prospective case series

Dina G Abdelzaher,Amr M Elshafei,Magda M Shady,Mahmoud Abdelatif,Waleed M Thabet

doi:10.1186/s43055-020-00165-7

Dina G Abdelzaher, Amr M Elshafei + Show 3 more

Open Access

https://doi.org/10.1186/s43055-020-00165-7

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Abstract

BackgroundPelvic floor dysfunction affects the lifestyle of women worldwide; the aim of this study is to evaluate the role of static MRI and dynamic MR defecography in the diagnosis of the posterior compartment of pelvic floor dysfunction.This prospective study included 50 female patients. All of them presented with pelvic floor dysfunction. Static and dynamic MRI were performed for all patients after injection of 120–150 ml of intrarectal gel and voiding 2 h before examination. Dynamic MRI was performed at rest, squeezing, straining phases, and during defecation.ResultsMR defecography can detect posterior compartment pathology with high sensitivity and specificity. We found anterior rectocele in 26 patients (52%). Rectocele incidence was analyzed and compared to postoperative reports, and the receiver operator curve (ROC) was calculated that showed area under the curve (AUC) of 0.998. The cut-off value of 1.95 cm gives a sensitivity of 96.4% and specificity of 100% during straining. The percentage of anismus was 26%, rectorectal intussusception 52%, anal prolapse types (rectoanal intussusception 14% and external prolapse 8%), and peritoneocele 34%.ConclusionMRI is a valuable imaging modality that can be used to diagnose pelvic floor disorders and does not involve the risk of exposure to ionizing radiation. It can direct the surgical procedure and thus improve the post-operative results and decrease the rate of recurrence due to missed pathology.

Highlights

Pelvic floor dysfunction affects the lifestyle of women worldwide; the aim of this study is to evaluate the role of static Magnetic resonance imaging (MRI) and dynamic Magnetic resonance (MR) defecography in the diagnosis of the posterior compartment of pelvic floor dysfunction
The MRI images were interpreted by 2 separate consultants who worked separately from each other, and some patients performed a conventional defecography to be used as a reference in case of image interpretation conflicts (Figs. 3, 4, 5, 6, 7, and 8). This prospective study was performed on 50 female patients between 5/2015 and 6/2018 using MRI defecography, and the mean age of the patients was 38.7 years
Every patient was tested during rest, squeezing, straining and defecation, H lines, and M lines were measured in all cases during rest and straining as shown in box plots below; the H line during rest was and during straining was, while the M line during rest was and during straining was (Fig. 9)

Summary

Introduction

Pelvic floor dysfunction affects the lifestyle of women worldwide; the aim of this study is to evaluate the role of static MRI and dynamic MR defecography in the diagnosis of the posterior compartment of pelvic floor dysfunction. This prospective study included 50 female patients. Conventional defecography is considered the standard in the diagnosis of pelvic floor disorders specially the posterior compartment [3]. With rapid development in MR imaging technology, MR defecography is a valuable tool for the diagnosis of complex pelvic floor disorders and is favorable in several aspects compared to conventional proctography. MR defecography allows for the visualization of all pelvic floor compartments in static and dynamic fashion [1]

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