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Neshatian L, Triadafilopoulos G, Wallace S, Jawahar A, Sheth V, Shen S, Gurland B. Increased Grades of Rectal Intussusception: Role of Decline in Pelvic Floor Integrity and Association With Dyssynergic Defecation. Am J Gastroenterol 2024; 119:946-956. [PMID: 37975595 DOI: 10.14309/ajg.0000000000002605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION The natural history of rectal intussusception (RI) is poorly understood. We hypothesized that decline in pelvic floor integrity and function leads to increasing RI grades. METHODS Retrospective analysis of a registry of patients with defecatory disorders with high-resolution anorectal manometry and magnetic resonance defecography was performed. Association of risk factors on increasing RI grades was assessed using logistic regression. RESULTS Analysis included a total of 238 women: 90 had no RI, 43 Oxford 1-2, 49 Oxford 3, and 56 Oxford 4-5. Age ( P = 0.017), vaginal delivery ( P = 0.008), and prior pelvic surgery ( P = 0.032) were associated with increased Oxford grades. Obstructive defecation symptoms and dyssynergic defecation were observed at relatively high rates across groups. Increased RI grades were associated with less anal relaxation at simulated defecation yet, higher rates of normal balloon expulsion ( P < 0.05), linked to diminished anal sphincter. Indeed, increased RI grades were associated with worsening fecal incontinence severity, attributed to higher rates of anal hypotension. Levator ani laxity, defined by increased levator hiatus length and its excessive descent at straining, was associated with increasing RI grades, independent of age, history of vaginal delivery, and pelvic surgeries and could independently predict increased RI grades. Concurrent anterior and posterior compartments, and visceral prolapse were associated with higher Oxford grades. DISCUSSION Our data suggest that decline in pelvic floor integrity with abnormal levator ani laxity is associated with increased RI grades, a process that is independent of age, history of vaginal deliveries, and/or pelvic surgeries, and perhaps related to dyssynergic defecation.
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Affiliation(s)
- Leila Neshatian
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - George Triadafilopoulos
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Shannon Wallace
- Women's Health Institute, Division of Urogynecology and Pelvic Floor Disorders, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Anugayathri Jawahar
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Vipul Sheth
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Sa Shen
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California, USA
| | - Brooke Gurland
- Division of Colorectal Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
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Wadhwani S, Ratnaparkhi C, Dhok A. Comparison of Dynamic Magnetic Resonance Defecography With Clinical Examination in Diagnosing Pelvic Floor Dysfunction: An Observational Study. Cureus 2023; 15:e51378. [PMID: 38292993 PMCID: PMC10825726 DOI: 10.7759/cureus.51378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Pelvic floor dysfunction (PFD) is frequently reported in both sexes. Dynamic magnetic resonance defecography (DMRD) is the preferred modality, mainly due to its superiority and complementary role in clinical examination. However, studies from the perspective of Indian patients are scarce and mostly restricted to females. Thus, we assessed the diagnostic performance of DMRD in patients with PFD and correlated the findings with those on clinical examination. MATERIALS AND METHODS This prospective, observational study involved 57 adult patients of either sex, presenting with pelvic floor symptoms (PFS) and diagnosed with PFD. Initially, the patients underwent clinical examination, and diagnosis was recorded. Subsequently, the patients were subjected to DMRD. The findings were correlated with the Pearson "r" correlation coefficient. RESULTS A significantly greater proportion of patients had involvement of multiple compartments (36 vs. 12, p<0.001), cystocele (23 vs. 8, p=0.002), and rectal prolapse (25 vs. 14, p=0.030) on DMRD than clinical examination, while there was no significant difference regarding uterine prolapse (p=0.789). Grading of cystocele and rectal prolapse as well as diagnosis of enterocele/peritoneocele, rectocele, and intussusception could be done only with DMRD. DMRD had a strong and significant correlation with clinical examination regarding cystocele (r=0.943, p=0.003), uterine prolapse (r=0.972, p=0.001), and rectal prolapse (r=0.951, p=0.001). CONCLUSIONS DMRD demonstrated significantly better performance in the diagnosis of multiple compartment involvement, cystocele, and rectal prolapse. DMRD and clinical examination were significantly correlated regarding the diagnosis of cystocele, uterine prolapse, and rectal prolapse. Thus, DMRD provides information, in addition to the clinical examination, and should be used in symptomatic patients.
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Affiliation(s)
- Sanajana Wadhwani
- Department of Radiodiagnosis and Imaging, National Cancer Institute, Nagpur, IND
| | - Chetana Ratnaparkhi
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Nagpur, IND
| | - Avinash Dhok
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Nagpur, IND
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Kämpfer C, Pieper CC. [Dynamic magnetic resonance imaging of the pelvic floor: clinical application]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:799-807. [PMID: 37783986 DOI: 10.1007/s00117-023-01223-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Dynamic magnetic resonance imaging (MRI) of the pelvic floor plays a key role in imaging complex pelvic floor dysfunction. The simultaneous detection of multiple findings in a complex anatomic setting renders correct analysis and clinical interpretation challenging. OBJECTIVES The most important aspects (anatomy of the pelvic floor, three compartment model, morphological and functional analysis, reporting) for a successful clinical use of dynamic MRI of the pelvic floor are summarized. MATERIALS AND METHODS Review of the scientific literature on dynamic pelvic MR imaging with special consideration of the joint recommendations provided by the expert panel of ESUR/ESGAR in 2016. RESULTS The pelvic floor is a complex anatomic structure, mainly formed by the levator ani muscle, the urethral support system and the endopelvic fascia. Firstly, morphological changes of these structures are analysed on the static sequences. Secondly, the functional analysis using the three compartment model is performed on the dynamic sequences during squeezing, straining and defecation. Pelvic organ mobility, pelvic organ prolapse, the anorectal angle and pelvic floor relaxation are measured and graded. The diagnosis of cystoceles, enteroceles, rectoceles, the uterovaginal as well as anorectal decent, intussusceptions and dyssynergic defecation should be reported using a structured report form. CONCLUSIONS A comprehensive analysis of all morphological and functional findings during dynamic MRI of the pelvic floor can provide information missed by other imaging modalities and hence alter therapeutic strategies.
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Affiliation(s)
- C Kämpfer
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland.
| | - C C Pieper
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
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Dawkins A, Sobieh A, Myers C, Schambach B, Nair R. MRI defecography revisited. At-rest pelvic floor measurements with and without rectal gel. Is there a difference? Abdom Radiol (NY) 2023; 48:1237-1245. [PMID: 36809560 DOI: 10.1007/s00261-023-03849-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/04/2023] [Accepted: 02/06/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE The authors sought to test if there was a difference in key pelvic floor measurements obtained during MR defecography at-rest, i.e., H-line, M-line and anorectal angle (ARA), before and after rectal gel administration. The authors also sought to determine if any observed differences would affect the interpretation of the defecography studies. METHODS Institutional Review Board approval was obtained. An abdominal fellow retrospectively reviewed the images of all patients who underwent MRI defecography at our institution from January 2018 through June 2021. The H-line, M-line and ARA values were remeasured on T2-weighted sagittal images, with and without rectal gel for each patient. RESULTS One hundred and eleven (111) studies were included in the analysis. 18% (N = 20) of patients satisfied the criterion for pelvic floor widening before gel administration based on H-line measurement. This increased to 27% (N = 30) after rectal gel (p = 0.08). 14.4% (N = 16) met the M-line measurement criterion for pelvic floor descent before gel administration. This increased to 38.7% after rectal gel (N = 43) (p < 0.001). 67.6% (N = 75) demonstrated an abnormal ARA prior to administration of rectal gel. This decreased to 58.6% (N = 65) after rectal gel administration (p = 0.07). The overall reporting discrepancies incurred by the presence or absence of rectal gel were 16.2%, 29.7% and 23.4% for H-line, M-line and ARA, respectively. CONCLUSION The instillation of gel during MR defecography can cause significant changes to the observed pelvic floor measurements at-rest. This in turn can influence the interpretation of defecography studies.
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Affiliation(s)
- Adrian Dawkins
- Department of Radiology, University of Kentucky, 800 Rose Street, Lexington, KY, 40536-0293, USA.
| | - Ahmed Sobieh
- Department of Radiology, University of Kentucky, 800 Rose Street, Lexington, KY, 40536-0293, USA
| | - Charles Myers
- Department of Radiology, University of Kentucky, 800 Rose Street, Lexington, KY, 40536-0293, USA
| | | | - Rashmi Nair
- Department of Radiology, University of Kentucky, 800 Rose Street, Lexington, KY, 40536-0293, USA
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Herbst CT, Emerich K, Mayr MA, Rudisch A, Kremser C, Talasz H, Kofler M. Time-Synchronized MRI-Assessment of Respiratory Apparatus Subsystems-A Feasibility Study. J Voice 2023:S0892-1997(22)00358-7. [PMID: 36642590 DOI: 10.1016/j.jvoice.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/02/2022] [Accepted: 11/02/2022] [Indexed: 01/15/2023]
Abstract
The thorax (TH), the thoracic diaphragm (TD), and the abdominal wall (AW) are three sub-systems of the respiratory apparatus whose displacement motion has been well studied with the use of magnetic resonance imaging (MRI). Another sub-system, which has however received less research attention with respect to breathing, is the pelvic floor (PF). In particular, there is no study that has investigated the displacement of all four sub-systems simultaneously. Addressing this issue, it was the purpose of this feasibility study to establish a data acquisition paradigm for time-synchronous quantitative analysis of dynamic MRI data from these four major contributors to respiration and phonation (TH, TD, AW, and PF). Three healthy females were asked to breathe in and out forcefully while being recorded in a 1.5-Tesla whole body MR-scanner. Spanning a sequence of 15.12 seconds, 40 MRI data frames were acquired. Each data frame contained two slices, simultaneously documenting the mid-sagittal (TH, TD, PF) and transversal (AW) planes. The displacement motion of the four anatomical structures of interest was documented using kymographic analysis, resulting in time-varying calibrated structure displacement data. After computing the fundamental frequency of the cyclical breathing motion, the phase offsets of the TH, PF, and AW with respect to the TD were computed. Data analysis revealed three fundamentally different displacement patterns. Total structure displacement was in the range of 0.94 cm (TH) to 4.27 cm (TD). Phase delays of up to 90∘ (i.e., a quarter of a breathing cycle) between different structures were found. Motion offsets in the range of -28.30∘ to 14.90∘ were computed for the PF with respect to the TD. The diversity of results in only three investigated participants suggests a variety of possible breathing strategies, warranting further research.
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Affiliation(s)
- Christian T Herbst
- Department of Vocal Studies, Mozarteum University, Salzburg, Austria; Janette Ogg Voice Research Center, Shenandoah Conservatory, Winchester, VA, USA.
| | - Kate Emerich
- University of Denver, Lamont School of Music, Newman Center for the Performing Arts, Denver, CO, USA; Vocal Essentials, LLC., Denver, CO, USA
| | - Michaela A Mayr
- Antonio Salieri Department of Vocal Studies and Vocal Research in Music Education, University of Music and Performing Arts, Vienna, Austria
| | - Ansgar Rudisch
- Department of Radiology, Medical University of Innsbruck, Austria
| | | | - Helena Talasz
- Department of Internal Medicine, Hochzirl Hospital, Zirl, Austria
| | - Markus Kofler
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
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Wang X, He D, Feng F, Ashton-Miller JA, DeLancey JOL, Luo J. Multi-label classification of pelvic organ prolapse using stress magnetic resonance imaging with deep learning. Int Urogynecol J 2022; 33:2869-2877. [PMID: 35083500 PMCID: PMC9325920 DOI: 10.1007/s00192-021-05064-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/05/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We aimed to develop a deep learning-based multi-label classification model to simultaneously diagnose three types of pelvic organ prolapse using stress magnetic resonance imaging (MRI). METHODS Our dataset consisted of 213 midsagittal labeled MR images at maximum Valsalva. For each MR image, the two endpoints of the sacrococcygeal inferior-pubic point line were auto-localized. Based on this line, a region of interest was automatically selected as input to a modified deep learning model, ResNet-50, for diagnosis. An unlabeled MRI dataset, a public dataset, and a synthetic dataset were used along with the labeled image dataset to train the model through a novel training strategy. We conducted a fivefold cross-validation and evaluated the classification results using precision, recall, F1 score, and area under the curve (AUC). RESULTS The average precision, recall, F1 score, and AUC of our proposed multi-label classification model for the three types of prolapse were 0.84, 0.72, 0.77, and 0.91 respectively, which were improved from 0.64, 0.53, 0.57, and 0.83 from the original ResNet-50. Classification took 0.18 s to diagnose one patient. CONCLUSIONS The proposed deep learning-based model were demonstrated feasible and fast in simultaneously diagnosing three types of prolapse based on pelvic floor stress MRI, which could facilitate computer-aided prolapse diagnosis and treatment planning.
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Affiliation(s)
- Xinyi Wang
- University of Michigan-Shanghai Jiao Tong University Joint Institute, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Da He
- University of Michigan-Shanghai Jiao Tong University Joint Institute, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Fei Feng
- University of Michigan-Shanghai Jiao Tong University Joint Institute, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - James A Ashton-Miller
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
| | - John O L DeLancey
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Jiajia Luo
- Biomedical Engineering Department, Peking University, Beijing, 100191, China.
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Neshatian L, Lam JP, Gurland BH, Liang T, Becker L, Sheth VR. MRI biomarker of muscle composition is associated with severity of pelvic organ prolapse. Tech Coloproctol 2022; 26:725-733. [PMID: 35727428 DOI: 10.1007/s10151-022-02651-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/29/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The pathophysiology of pelvic organ prolapse is largely unknown. We hypothesized that reduced muscle mass on magnetic resonance defecography (MRD) is associated with increased pelvic floor laxity. The aim of this study was to compare the psoas and puborectalis muscle mass composition and cross-sectional area among patients with or without pelvic laxity. METHODS An observational retrospective study was conducted on women > age 18 years old who had undergone MRD for pelvic floor complaints from January 2020 to December 2020 at Stanford Pelvic Health Center. Pelvic floor laxity, pelvic organ descent, and rectal prolapse were characterized by standard measurements on MRD and compared to the psoas (L4 level) and puborectalis muscle index (cross-sectional area adjusted by height) and relative fat fraction, quantified by utilizing a 2-point Dixon technique. Regression analysis was used to quantify the association between muscle characteristics and pelvic organ measurements. RESULTS The psoas fat fraction was significantly elevated in patients with abnormally increased resting and strain H and M lines (p < 0.05) and increased with rising grades of Oxford rectal prolapse (p = 0.0001), uterovaginal descent (p = 0.001) and bladder descent (p = 0.0005). In multivariate regression analysis, adjusted for age and body mass index, the psoas fat fraction (not muscle index) was an independent risk factor for abnormal strain H and M line; odds ratio (95% confidence interval) of 17.8 (2-155.4) and 18.5 (1.3-258.3) respectively, and rising Oxford grade of rectal prolapse 153.9 (4.4-5383) and bladder descent 12.4 (1.5-106). Puborectalis fat fraction was increased by rising grades of Oxford rectal prolapse (p = 0.0002). CONCLUSIONS Severity of pelvic organ prolapse appears to be associated with increasing psoas muscle fat fraction, a biomarker for reduced skeletal muscle mass. Future prospective research is needed to determine if sarcopenia may predict postsurgical outcomes after pelvic organ prolapse repair.
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Affiliation(s)
- L Neshatian
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, CA, Stanford, USA.
| | - J P Lam
- American Radiology Associates, Dallas, TX, USA
| | - B H Gurland
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - T Liang
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - L Becker
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, CA, Stanford, USA
| | - V R Sheth
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
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Nomura Y, Okada Y, Nakagawa C, Kurokawa I, Shigeta M, Fujisawa H, Yoshimura Y. Magnetic resonance imaging evaluation of the effectiveness of FemiCushion in pelvic organ prolapse. J Obstet Gynaecol Res 2022; 48:1255-1264. [PMID: 35229411 PMCID: PMC9311198 DOI: 10.1111/jog.15210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 11/26/2022]
Abstract
Aims FemiCushion (FC) is a supportive device for pelvic organ prolapse (POP), but its effectiveness has not been evaluated with imaging studies. This study utilized magnetic resonance imaging (MRI) to evaluate the anatomic changes induced by FC use in patients with severe POP. Methods This prospective study examined patients with stage 3 or 4 POP who underwent treatment with FC and received a diagnostic MRI. Measurements were made in the midsagittal plane at rest and during straining with and without FC. The vertical distances from the lowest points of the anterior and posterior vaginal wall (A; P), uterine cervix or vaginal stump (C), and perineal body (PB) to the Pelvic Inclination Correction System line were measured, along with the lengths of the urogenital (UGH) and levator hiatus (LH). Results Twelve patients were included in the study. The median age was 72 (range, 56–84) years. All reference points were positioned significantly higher with the FC than without the FC (median ΔA: 11 mm, p = 0.005; ΔC: 14 mm, p = 0.011; ΔP: 6 mm, p = 0.008; ΔPB: 7 mm, p = 0.002). Median UGH and LH lengths during straining were significantly shorter with the FC than without the FC (UGH: 44 mm vs. 53 mm, p = 0.002; LH: 60 vs. 65 mm, p = 0.021). Conclusions This is the first report on the use of MRI to measure the performance of FC. Our study demonstrates that FC effectively repositioned the organs involved in POP.
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Affiliation(s)
- Yukiko Nomura
- Department of Female Pelvic Health Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan.,Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Yoshiyuki Okada
- Department of Female Pelvic Health Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan.,Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Chie Nakagawa
- Department of Female Pelvic Health Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan.,Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Ippei Kurokawa
- Department of Female Pelvic Health Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan.,Department of Urology, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Miwa Shigeta
- Department of Female Pelvic Health Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Hidefumi Fujisawa
- Department of Radiology, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Yasukuni Yoshimura
- Department of Female Pelvic Health Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan.,Department of Urology, Showa University Northern Yokohama Hospital, Kanagawa, Japan
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Yagi T, Kodama M, Bun M, Shimura H, Sawada K, Endo M, Kimura T. Magnetic resonance imaging evaluation of pelvic floor structure during pregnancy. Eur J Obstet Gynecol Reprod Biol 2021; 264:289-293. [PMID: 34352425 DOI: 10.1016/j.ejogrb.2021.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/07/2021] [Accepted: 07/25/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Among the various risk factors of pelvic floor disorders, pregnancy has been reported to affect the pelvic floor structure; however, not all these effects have been understood yet. The aim of this study is to elucidate how pregnancy affects pelvic floor structure via magnetic resonance imaging (MRI). STUDY DESIGN We conducted a retrospective study between January 2010 and December 2019 to extract clinical records of pregnant and non-pregnant women, who underwent MRI for obstetrical diseases and ovarian benign tumors, respectively. The data on age, body mass index (BMI), complications, gravida, parity, gestational age, and obstetrical history were collected, and pubo-coccygeal line (PCL), pubo-rectal line (PRL), and M line (ML) on their MR images were measured. Statistical analyses were performed with Wilcoxon test, chi-square test, and Kruskal-Wallis test with Steel-Dwass post hoc test as appropriate. Statistical significance was set at P < 0.05. RESULTS We analyzed the reports of 56 (pregnancy group) and 106 women (non-pregnancy group). There was no significant difference in age or BMI, while the obstetric history was significantly different between these groups. Median PCL, PRL, and ML in the pregnancy group were significantly longer than those in the non-pregnancy group (114.1 mm vs. 110.0 mm, P = 0.018; 48.6 mm vs. 41.6 mm, P < 0.0001 and 21.7 mm vs. 10.0 mm, p < 0.0001. respectively). The subgroup analysis of the effect of pregnancy and vaginal delivery (VD) history on changes in these lines revealed that pregnancy-induced PRL increase tended to recover to the reference level of "non-pregnant without VD," but ML increase did not fully recover. CONCLUSION MRI revealed a strong effect of pregnancy on pelvic floor structure.
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Affiliation(s)
- Taro Yagi
- Osaka University Graduate School of Medicine, Department of Obstetrics and Gynecology, 2-2, Yamada-oka, Suita-city, Osaka, Japan.
| | - Michiko Kodama
- Osaka University Graduate School of Medicine, Department of Obstetrics and Gynecology, 2-2, Yamada-oka, Suita-city, Osaka, Japan.
| | - Michiko Bun
- Osaka University Graduate School of Medicine, Department of Obstetrics and Gynecology, 2-2, Yamada-oka, Suita-city, Osaka, Japan
| | - Hiroko Shimura
- Osaka University Graduate School of Medicine, Department of Obstetrics and Gynecology, 2-2, Yamada-oka, Suita-city, Osaka, Japan
| | - Kenjiro Sawada
- Osaka University Graduate School of Medicine, Department of Obstetrics and Gynecology, 2-2, Yamada-oka, Suita-city, Osaka, Japan.
| | - Masayuki Endo
- Osaka University Graduate School of Medicine, Department of Obstetrics and Gynecology, 2-2, Yamada-oka, Suita-city, Osaka, Japan.
| | - Tadashi Kimura
- Osaka University Graduate School of Medicine, Department of Obstetrics and Gynecology, 2-2, Yamada-oka, Suita-city, Osaka, Japan.
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Abstract
Complete rectal prolapse or rectal procidentia is a debilitating disease that presents with fecal incontinence, constipation, and rectal discharge. Definitive surgical techniques described for this disease include perineal procedures such as mucosectomy and rectosigmoidectomy, and abdominal procedures such as rectopexy with or without mesh and concomitant resection. The debate over these techniques regarding the lowest recurrence and morbidity rates, and the best functional outcomes for constipation or incontinence, has been going on for decades. The heterogeneity of available studies does not allow us to draw firm conclusions. This article aims to review the surgical techniques for complete rectal prolapse based on the current evidence base regarding surgical and functional outcomes.
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Jourdan A, Le Troter A, Daude P, Rapacchi S, Masson C, Bège T, Bendahan D. Semiautomatic quantification of abdominal wall muscles deformations based on dynamic MRI image registration. NMR IN BIOMEDICINE 2021; 34:e4470. [PMID: 33525062 DOI: 10.1002/nbm.4470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/14/2020] [Indexed: 06/12/2023]
Abstract
Quantitative analysis of abdominal organs motion and deformation is crucial to better understand biomechanical alterations undermining respiratory, digestive or perineal pathophysiology. In particular, biomechanical characterization of the antero-lateral abdominal wall is central in the diagnosis of abdominal muscle deficiency. Here, we present a dedicated semiautomatic dynamic MRI postprocessing method enabling the quantification of spatial and temporal deformations of the antero-lateral abdominal wall muscles. Ten healthy participants were imaged during a controlled breathing session at the L3-L4 disc level using real-time dynamic MRI at 3 T. A coarse feature-tracking step allowed the selection of the inhalation cycle of maximum abdominal excursion. Over this image series, the described method combines (1) a supervised 2D+t segmentation procedure of the abdominal wall muscles, (2) the quantification of muscle deformations based on masks registration, and (3) the mapping of deformations within muscle subzones leveraging a dedicated automatic parcellation. The supervised 2D+t segmentation (1) provided an accurate segmentation of the abdominal wall muscles throughout maximum inhalation with a 0.95 ± 0.03 Dice similarity coefficient (DSC) value and a 2.3 ± 0.7 mm Hausdorff distance value while requiring only manual segmentation of 20% of the data. The robustness of the deformation quantification (2) was indicated by high indices of correspondence between the registered source mask and the target mask (0.98 ± 0.01 DSC value and 2.1 ± 1.5 mm Hausdorff distance value). Parcellation (3) enabled the distinction of muscle substructures that are anatomically relevant but could not be distinguished based on image contrast. The present genuine postprocessing method provides a quantitative analytical frame that could be used in further studies for a better understanding of abdominal wall deformations in physiological and pathological situations.
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Affiliation(s)
- Arthur Jourdan
- Aix-Marseille Université, Université Gustave Eiffel, LBA, Marseille, France
| | | | - Pierre Daude
- Aix Marseille Université, CNRS, CRMBM, Marseille, France
| | | | - Catherine Masson
- Aix-Marseille Université, Université Gustave Eiffel, LBA, Marseille, France
| | - Thierry Bège
- Aix-Marseille Université, Université Gustave Eiffel, LBA, Marseille, France
- Department of General Surgery, Aix Marseille Université, North Hospital, APHM, Marseille, France
| | - David Bendahan
- Aix Marseille Université, CNRS, CRMBM, Marseille, France
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Pollock GR, Twiss CO, Chartier S, Vedantham S, Funk J, Arif Tiwari H. Comparison of magnetic resonance defecography grading with POP-Q staging and Baden-Walker grading in the evaluation of female pelvic organ prolapse. Abdom Radiol (NY) 2021; 46:1373-1380. [PMID: 31720767 DOI: 10.1007/s00261-019-02313-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The physical examination and pelvic imaging with MRI are often used in the pre-operative evaluation of pelvic organ prolapse. The objective of this study was to compare grading of prolapse on defecography phase of dynamic magnetic resonance imaging (dMRI) with physical examination (PE) grading using both the Pelvic Organ Prolapse Quantification (POP-Q) staging and Baden-Walker (BW) grading systems in the evaluation of pelvic organ prolapse (POP). METHODS We retrospectively reviewed the charts of 170 patients who underwent dMRI at our institution. BW grading and POP-Q staging were collected for anterior, apical, and posterior compartments, along with absolute dMRI values and overall grading of dMRI. For the overall grading/staging from dMRI, BW, and POP-Q, Spearman rho (ρ) was used to assess the correlation. The correlations between dMRI grading and POP-Q staging were compared to the correlations between dMRI grading and BW grading using Fisher's Z transformation. RESULTS A total of 54 patients were included. dMRI grading was not significantly correlated with BW grading for anterior, apical, and posterior compartment prolapse (p > 0.15). However, overall dMRI grading demonstrated a significant (p = 0.025) and positive correlation (ρ = 0.305) with the POP-Q staging system. dMRI grading for anterior compartment prolapse also demonstrated a positive correlation (p = 0.001, ρ = 0.436) with the POP-Q staging derived from measurement locations Aa and Ba. The overall dMRI grade is better correlated with POP-Q stage than with BW grade (p = 0.024). CONCLUSION Overall and anterior compartment grading from dMRI demonstrated a significant and positive correlation with the overall POP-Q staging and anterior compartment POP-Q staging, respectively. The overall dMRI grade is better correlated with POP-Q staging than with BW grading.
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Affiliation(s)
- Grant R Pollock
- Department of Urology, University of Arizona College of Medicine Tucson, 1501 N. Campbell Avenue, PO Box 245077, Tucson, AZ, 85724-5077, USA.
| | - Christian O Twiss
- Department of Urology, University of Arizona College of Medicine Tucson, 1501 N. Campbell Avenue, PO Box 245077, Tucson, AZ, 85724-5077, USA
| | - Stephane Chartier
- Arizona College of Osteopathic Medicine, Midwestern University, 19555 N 59th Ave, Glendale, AZ, 85308, USA
| | - Srinivasan Vedantham
- Department of Medical Imaging, University of Arizona College of Medicine Tucson, 1501 N. Campbell Avenue, PO Box 245067, Tucson, AZ, 85724, USA
| | - Joel Funk
- Department of Urology, University of Arizona College of Medicine Tucson, 1501 N. Campbell Avenue, PO Box 245077, Tucson, AZ, 85724-5077, USA
| | - Hina Arif Tiwari
- Department of Medical Imaging, University of Arizona College of Medicine Tucson, 1501 N. Campbell Avenue, PO Box 245067, Tucson, AZ, 85724, USA
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Lalwani N, Khatri G, El Sayed RF, Ram R, Jambhekar K, Chernyak V, Kamath A, Lewis S, Flusberg M, Scholz F, Arif-Tiwari H, Palmer SL, Lockhart ME, Fielding JR. MR defecography technique: recommendations of the society of abdominal radiology's disease-focused panel on pelvic floor imaging. Abdom Radiol (NY) 2021; 46:1351-1361. [PMID: 31385010 DOI: 10.1007/s00261-019-02160-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE To develop recommendations for magnetic resonance (MR) defecography technique based on consensus of expert radiologists on the disease-focused panel of the Society of Abdominal Radiology (SAR). METHODS An extensive questionnaire was sent to a group of 20 experts from the disease-focused panel of the SAR. The questionnaire encompassed details of technique and MRI protocol used for evaluating pelvic floor disorders. 75% agreement on questionnaire responses was defined as consensus. RESULTS The expert panel reached consensus for 70% of the items and provided the basis of these recommendations for MR defecography technique. There was unanimous agreement that patients should receive coaching and explanation of commands used during MR defecography, the rectum should be distended with contrast agent, and that sagittal T2-weighted images should include the entire pelvis within the field of view. The panel also agreed unanimously that IV contrast should not be used for MR defecography. Additional areas of consensus ranged in agreement from 75 to 92%. CONCLUSION We provide a set of consensus recommendations for MR defecography technique based on a survey of expert radiologists in the SAR pelvic floor dysfunction disease-focused panel. These recommendations can be used to develop a standardized imaging protocol.
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Affiliation(s)
- Neeraj Lalwani
- Wake Forest University Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | - Gaurav Khatri
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Roopa Ram
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kedar Jambhekar
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Victoria Chernyak
- Albert Einstein College of Medicine, Montefiore Medical Center, The Bronx, NY, USA
| | - Amita Kamath
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sara Lewis
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Milana Flusberg
- Department of Radiology, Westchester Medical Center, Valhalla, NY, USA
| | | | | | - Suzanne L Palmer
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mark E Lockhart
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Julia R Fielding
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
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Santos Junior LC, Brito LGO, Castro EBD, Dertkigil S, Juliato CRT. Mid- to Long-Term Magnetic Resonance Imaging Results of Two Prolapse Surgeries for Apical Defect: A Secondary Analysis of a Randomized Controlled Trial. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:46-53. [PMID: 33513636 PMCID: PMC10183877 DOI: 10.1055/s-0040-1718441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) has been considered another tool for use during the pre- and postoperative periods of the management of pelvic-organ prolapse (POP). However, there is little consensus regarding its practical use for POP and the association between MRI lines of reference and physical examination. We aimed to evaluate the mid- to long-term results of two surgical techniques for apical prolapse. METHODS In total, 40 women with apical POP randomized from 2014 to 2016 underwent abdominal sacrocolpopexy (ASC group; n = 20) or bilateral vaginal sacrospinous fixation with an anterior mesh (VSF-AM group; n = 20). A physical examination using the POP Quantification System (POP-Q) for staging (objective cure) and the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS: subjective cure), were applied and analyzed before and one year after surgery respectively. All MRI variables (pubococcigeous line [PCL], bladder base [BB], anorectal junction [ARJ], and the estimated levator ani subtended volume [eLASV]) were investigated one year after surgery. Significance was established at p < 0.05. RESULTS After a mean 27-month follow-up, according to the MRI criteria, 60% of the women were cured in the VSF-AM group versus 45% in ASC group (p = 0.52). The POP-Q and objective cure rates by MRI were correlated in the anterior vaginal wall (p = 0.007), but no correlation was found with the subjective cure. The eLASV was larger among the patients with surgical failure, and a cutoff of ≥ 33.5 mm3 was associated with postoperative failure (area under the receiver operating characteristic curve [ROC]: 0.813; p = 0.002). CONCLUSION Both surgeries for prolapse were similar regarding the objective variables (POP-Q measurements and MRI cure rates). Larger eLASV areas were associated with surgical failure.
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Affiliation(s)
- Luiz Carlos Santos Junior
- Department of Obstetrics and Gynecology, Pelvic Floor Dysfunction Division, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Luiz Gustavo Oliveira Brito
- Department of Obstetrics and Gynecology, Pelvic Floor Dysfunction Division, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Edilson Benedito de Castro
- Department of Obstetrics and Gynecology, Pelvic Floor Dysfunction Division, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Sergio Dertkigil
- Department of Obstetrics and Gynecology, Pelvic Floor Dysfunction Division, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Cassia Raquel Teatin Juliato
- Department of Obstetrics and Gynecology, Pelvic Floor Dysfunction Division, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
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Feasibility of a deep learning-based method for automated localization of pelvic floor landmarks using stress MR images. Int Urogynecol J 2021; 32:3069-3075. [PMID: 33475815 DOI: 10.1007/s00192-020-04626-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/19/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Magnetic resonance imaging (MRI) plays an important role in assessing pelvic organ prolapse (POP), and automated pelvic floor landmark localization potentially accelerates MRI-based measurements of POP. Herein, we aimed to develop and evaluate a deep learning-based technique for automated localization of POP-related landmarks. METHODS Ninety-six mid-sagittal stress MR images (at rest and at maximal Valsalva) were used for deep-learning model training and generalization testing. We randomly split our dataset into a training set of 73 images and a testing set of 23 images. One soft-tissue landmark (the cervical os [P1]) and three bony landmarks (the mid-pubic line [MPL] endpoints [P2&P3] and the sacrococcygeal inferior-pubic point [SCIPP] line endpoints [P3&P4]) were annotated by experts. We used an encoder-decoder structure to develop the deep learning model for automated localization of the four landmarks. Localization performance was assessed using the root square error (RSE), whereas the reference lines were assessed based on the length and orientation differences. RESULTS We localized landmarks (P1 to P4) with mean RSEs of 1.9 mm, 1.3 mm, 0.9 mm, and 3.6 mm. The mean length errors of the MPL and SCIPP line were 0.1 and -2.1 mm, and the mean orientation errors of the MPL and SCIPP line were -0.7° and -0.3°. Our method predicted each image in 0.015 s. CONCLUSIONS We demonstrated the feasibility of a deep learning-based approach for accurate and fast fully automated localization of bony and soft-tissue landmarks. This sped up the MR interpretation process for fast POP screening and treatment planning.
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Srisajjakul S, Prapaisilp P, Bangchokdee S. Diagnostic clues, pitfalls, and imaging characteristics of '-celes' that arise in abdominal and pelvic structures. Abdom Radiol (NY) 2020; 45:3638-3652. [PMID: 32356005 DOI: 10.1007/s00261-020-02546-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
'-Celes' is an ancient Greek language suffix that means 'tumor,' 'hernia,' 'swelling,' or 'cavity.' There are many '-celes' in the abdomen and pelvis that may be encountered during routine imaging interpretation, including santorinicele, choledochocele, ureterocele, lymphocele, mucocele, rectocele, cystocele, peritoneocele, varicocele, spermatocele, hydrocele, hematocele, pyocele and syringocele. Most '-celes' are detected incidentally at imaging for other clinical indications, but some deserve more attention due to a range of clinical symptoms or functional disorder that can adversely affect patient quality of life. The objective of this article was to address all of the '-celes' that a general radiologist and abdominal radiologist should know and be able to recognize. Imaging characteristics, diagnostic clues, and pitfalls have been provided to improve diagnostic accuracy and patient outcomes.
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Affiliation(s)
- Sitthipong Srisajjakul
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
| | - Patcharin Prapaisilp
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Sirikan Bangchokdee
- Department of Internal Medicine, Pratumthani Hospital, 7 Ladlumkaew Muang District, Pratumtani, 12000, Thailand
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Laitakari KE, Mäkelä-Kaikkonen JK, Pääkkö E, Kata I, Ohtonen P, Mäkelä J, Rautio TT. Restored pelvic anatomy is preserved after laparoscopic and robot-assisted ventral rectopexy: MRI-based 5-year follow-up of a randomized controlled trial. Colorectal Dis 2020; 22:1667-1676. [PMID: 32544283 DOI: 10.1111/codi.15195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 05/13/2020] [Indexed: 12/12/2022]
Abstract
AIM Our aim was to compare the long-term anatomical outcomes between robot-assisted ventral mesh rectopexy (RVMR) and laparoscopic ventral mesh rectopexy (LVMR) for external or internal rectal prolapse. METHOD This study is a follow-up of a single-centre randomized controlled trial (RCT). Thirty patients were randomly allocated to RVMR (n = 16) or LVMR (n = 14). The primary end-point was maintenance of the restored pelvic anatomy 5 years after the operation, as assessed by magnetic resonance (MR) defaecography. Secondary outcome measures included the Pelvic Organ Prolapse Quantification (POP-Q) measures and functional results assessed using symptom questionnaires. RESULTS Twenty-six patients (14 RVMR and 12 LVMR) completed the 5-year follow-up and were included in the study. The MRI results, POP-Q measurements and symptom-specific quality of life measures did not differ between the RVMR and LVMR groups. The MRI measurements of the total study population remained unchanged between 3 months and 5 years. In the Pelvic Floor Distress Inventory (PFDI-20), the RVMR group had lower symptom scores (mean 96.0, SD 70.7) than the LVMR group (mean 160.6, SD 58.9; P = 0.004). In the subscales of pelvic organ prolapse (POPDI-6) (mean 23.2, SD 24.3 vs mean 52.4, SD 22.4; P = 0.001) and the Colorectal-Anal Distress Inventory (CRADI-8) (mean 38.4, SD 23.3 vs mean 58.6, SD 25.4; P = 0.009), the patients in the RVMR group had significantly better outcomes. CONCLUSION After VMR, the corrected anatomy was preserved. There were no clinically significant differences in anatomical results between the RVMR and LVMR procedures 5 years after surgery based on MR defaecography. However, functional outcomes were better after RMVR.
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Affiliation(s)
- K E Laitakari
- Department of Surgery, Division of Gastroenterology, Oulu University Hospital, Oulu, Finland.,Medical Research Center Oulu, Center of Surgical Research, University of Oulu, Oulu, Finland
| | - J K Mäkelä-Kaikkonen
- Department of Surgery, Division of Gastroenterology, Oulu University Hospital, Oulu, Finland.,Medical Research Center Oulu, Center of Surgical Research, University of Oulu, Oulu, Finland
| | - E Pääkkö
- Department of Radiology, Oulu University Hospital, Oulu, Finland
| | - I Kata
- Department of Radiology, Oulu University Hospital, Oulu, Finland
| | - P Ohtonen
- Medical Research Center Oulu, Center of Surgical Research, University of Oulu, Oulu, Finland.,Division of Operative Care, Oulu University Hospital, Oulu, Finland
| | - J Mäkelä
- Department of Surgery, Division of Gastroenterology, Oulu University Hospital, Oulu, Finland.,Medical Research Center Oulu, Center of Surgical Research, University of Oulu, Oulu, Finland
| | - T T Rautio
- Department of Surgery, Division of Gastroenterology, Oulu University Hospital, Oulu, Finland.,Medical Research Center Oulu, Center of Surgical Research, University of Oulu, Oulu, Finland
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18
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Shatkin-Margolis A, Duke E, Ghodsi V, Hill A, Crisp CC, Pauls RN. Dynamic magnetic resonance imaging following native tissue vaginal reconstructive surgery; a prospective study. Int Urogynecol J 2020; 32:1519-1525. [PMID: 33089350 DOI: 10.1007/s00192-020-04571-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/14/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To describe the impact of native tissue vaginal reconstruction on pelvic anatomy using dynamic magnetic resonance imaging. METHODS This prospective single-cohort observational study involved women undergoing native tissue reconstruction with intraperitoneal vaginal vault suspension for pelvic organ prolapse. Concomitant procedures such as hysterectomy, midurethral sling, and anterior or posterior colporrhaphy were allowed. Enrolled participants underwent dynamic pelvic imaging pre- and postoperatively. Radiographic and anatomic measurements were compared. Secondary outcomes included validated patient questionnaires. RESULTS Fourteen participants were included in the analysis. The mean age was 62 years; all participants were Caucasian. Most participants had stage III pelvic organ prolapse. Significant improvements were noted in several radiographic measurements. The average H-line (representing levator hiatus width) with straining maneuvers improved following surgery (7.2 cm preoperatively vs. 6.6 cm postoperatively, p = 0.015). The average M-line (representing levator muscular descent) improved significantly with both straining (4.0 cm preoperatively vs. 3.0 cm postoperatively, p < 0.001) and defecatory maneuvers (6.2 cm preoperatively vs. 5.2 cm postoperatively, p = 0.001). The average size of cystocele improved from 5.6 cm (moderate) preoperatively to 0.7 cm (absent descent) postoperatively (p < 0.001). The average descent of the vaginal apex with defecation preoperatively was 3.0 cm (moderate) and 0 cm (absent descent) postoperatively (p = 0.003). Posterior compartment descent with defecation did not change following surgical intervention (5.8 cm preoperatively vs. 5.2 cm postoperatively, p = 0.056). Pelvic Organ Prolapse Quantification measurements improved in all compartments, and Pelvic Floor Distress Inventory-20 scores improved significantly following surgery (102 preoperatively vs. 30 postoperatively, p < 0.001). CONCLUSIONS Native tissue reconstruction with intraperitoneal vaginal vault suspension resulted in significant anatomic improvements, as defined by physical examination and dynamic magnetic resonance imaging.
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Affiliation(s)
- Abigail Shatkin-Margolis
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, Good Samaritan Hospital TriHealth, Cincinnati, OH, USA. .,Kaiser Permanente - Dublin Medical Offices & Cancer Center, 3100 Dublin Blvd., Dublin, CA, 94568, USA.
| | - Eugene Duke
- Department of Radiology, Good Samaritan Hospital TriHealth, Cincinnati, OH, USA
| | - Vivian Ghodsi
- Division of Female Pelvic Medicine and Reconstructive Surgery, TriHealth Hatton Research Institute, Cincinnati, OH, USA
| | - Austin Hill
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, Good Samaritan Hospital TriHealth, Cincinnati, OH, USA
| | - Catrina C Crisp
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, Good Samaritan Hospital TriHealth, Cincinnati, OH, USA
| | - Rachel N Pauls
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, Good Samaritan Hospital TriHealth, Cincinnati, OH, USA
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Ribeiro AM, Nammur LG, Mateus-Vasconcelos ECL, Ferreira CHJ, Muglia VF, de Oliveira HF. Pelvic floor muscles after prostate radiation therapy: morpho-functional assessment by magnetic resonance imaging, surface electromyography and digital anal palpation. Int Braz J Urol 2020; 47:120-130. [PMID: 33047917 PMCID: PMC7712707 DOI: 10.1590/s1677-5538.ibju.2019.0765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/12/2020] [Indexed: 11/21/2022] Open
Abstract
Aim: To evaluate the radiotherapy (RT) effect in the pelvic floor muscles (PFM) function in men with prostate cancer (PC). Materials and Methods: A cross-sectional study included three groups of patients with PC and RT indication: 1) Pre-RT group: evaluated before the beginning of RT; 2) Acute group: evaluated between six months and one year after RT; 3) Late Group: evaluated between two and a half years and four years post-RT. PFM assessment was divided into: a) functional assessment through the digital anal palpation (Modified Oxford Scale) and surface electromyography (sEMG) with anal probe; b) anatomical assessment by pelvic magnetic resonance imaging (MRI) with thickness measurements of levator ani muscle and pelvic specific parameters at rest and under Valsalva maneuver. We used Student t test, considering as significant p <0.05. Results: Thirty-three men were assessed: Pre-RT (n=12); Acute (n=10) and Late (n=11) groups. PFM functional assessment showed Late group with lower electromyographic activity, especially in the sustained contractions when compared to the Pre-RT (p=0.003) and Acute groups (p=0.006). There was no significant difference between groups in MRI. Conclusion: PFM functional assessment showed a decrease in sEMG activity in the Late group post-RT. Most of the sample (72.7%) did not know how to actively contract the PFM or had a weak voluntary contraction when assessed by digital anal palpation. Also, these patients presented higher prevalence of pelvic complaints. No changes were observed in the morpho-functional parameters evaluated by MRI, except the measurement of the membranous urethra length when comparing Pre-RT Group and Acute and Late Groups.
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Affiliation(s)
- Aline Moreira Ribeiro
- Departamento de Ciências da Saúde, Curso de Educação Física, Centro Mineiro do Ensino Superior, Campo Belo, MG, Brasil
| | - Larissa Guerra Nammur
- Faculdade de Fisioterapia e Educação Física, Universidade Federal de Uberlândia, Uberlândia, MG, Brasil
| | | | - Cristine Homsi Jorge Ferreira
- Departamento de Biomecânica, Medicina e Reabilitação do Sistema Locomotor, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Valdair Francisco Muglia
- Departamento de Clínica Médica, Divisão de Radiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Harley Francisco de Oliveira
- Departamento de Clínica Médica, Divisão de Radioterapia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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20
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Routzong MR, Rostaminia G, Bowen ST, Goldberg RP, Abramowitch SD. Statistical shape modeling of the pelvic floor to evaluate women with obstructed defecation symptoms. Comput Methods Biomech Biomed Engin 2020; 24:122-130. [PMID: 32885671 DOI: 10.1080/10255842.2020.1813281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Obstructed defecation (OD) is common and may be related to compromised pelvic floor integrity. Magnetic resonance (MR) defecography and statistical shape modeling were used to define pelvic floor shape variations, hypothesizing that State (rest vs peak evacuation) and Group (control vs case) would significantly influence shape. 16 women underwent MR defecography (9 cases vs 7 controls). Midsagittal, 2D pelvic floors were segmented and aligned by corresponding points. Principal component scores were compared using a Two-Way Mixed MANOVA. Three modes described differences between State (p < 0.001) and Group (p = 0.023). The pelvic floor shape differed significantly between women with and without OD and during evacuation.
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Affiliation(s)
- Megan R Routzong
- Translational Biomechanics Laboratory, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ghazaleh Rostaminia
- Female Pelvic Medicine and Reconstructive Surgery (FPMRS), Division of Urogynecology, University of Chicago Pritzker School of Medicine, Northshore University HealthSystem, Skokie, IL, USA
| | - Shaniel T Bowen
- Translational Biomechanics Laboratory, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Roger P Goldberg
- Female Pelvic Medicine and Reconstructive Surgery (FPMRS), Division of Urogynecology, University of Chicago Pritzker School of Medicine, Northshore University HealthSystem, Skokie, IL, USA
| | - Steven D Abramowitch
- Translational Biomechanics Laboratory, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
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21
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Orazov MR, Toktar L, Rybina A, Gevorgian D, Dostieva S, Lologaeva M, Karimova G. MAGNETIC RESONANCE IMAGING OF PELVIC FLOOR DYSFUNCTION, REVIEW. REPRODUCTIVE MEDICINE 2020. [DOI: 10.37800/rm2020-1-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pelvic floor dysfunction is an important medical and social problem in the female population. The impact of pelvic floor disorders (PFD) is likely to grow as the prevalence of these disorders increases with an aging population. Pregnancy and delivery are considered major risk factors in the development of POP and stress urinary incontinence. Pelvic floor dysfunction may involve pelvic organ prolapse and/or pelvic floor relaxation. Organ prolapse can include any combination of the following: urethra (urethrocele), bladder (cystocele), or both (cystourethrocele), vaginal vault and cervix (vaginal vault prolapse), uterus (uterineprolapse), rectum (rectocele), sigmoid colon (sigmoidocele),and small bowel (enterocele).Given the paucity of understanding of PFD pathophysiology ,multicompartmental pathology, the high rate of recurrence and repeat surgery imaging plays a major role in its clinical management.The magnetic resonance imaging (MRI) allows noninvasive, radiation-free, rapid, high-resolution evaluation the multicompartment defects in one examination.Findings reported at MR imaging of the pelvic floor are valuable for selecting candidates for surgical treatment and for indicating the most appropriate surgical approach.
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22
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El Sayed RF. Integrated MR Analytical Approach and Reporting of Pelvic Floor Dysfunction: Current Implications and New Horizons. Radiol Clin North Am 2020; 58:305-327. [PMID: 32044009 DOI: 10.1016/j.rcl.2019.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Reporting MR imaging of pelvic floor dysfunction can be made easy if radiologists understand the aim of each MR sequence and what to report in each set of MR images. For an MR imaging report that is critical in decision making for patient management, it is of paramount importance to the radiologist to know what to look for and where to look for it. This article presents a new term, integrated MR analytical approach. A reporting template is included in which all MR findings are presented in a schematic form that can be easily interpreted by clinicians from different subspecialties.
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Affiliation(s)
- Rania Farouk El Sayed
- Cairo University MRI Pelvic Floor Center of Excellency and Research Lab Unit, Department of Radiology, Cairo University Hospitals, Kasr El Ainy Street, Cairo 11956, Egypt.
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23
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Pelvic floor dysfunctions: how to image patients? Jpn J Radiol 2019; 38:47-63. [DOI: 10.1007/s11604-019-00903-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 11/21/2019] [Indexed: 12/13/2022]
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24
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Putz C, Alt CD, Wagner B, Gantz S, Gerner HJ, Weidner N, Grenacher L, Hensel C. MR defecography detects pelvic floor dysfunction in participants with chronic complete spinal cord injury. Spinal Cord 2019; 58:203-210. [PMID: 31506586 DOI: 10.1038/s41393-019-0351-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 07/21/2019] [Accepted: 07/22/2019] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN A prospective single arm study. OBJECTIVES Previously we have demonstrated that magnetic resonance (MR) defecography is feasible in participants with complete spinal cord injury (SCI). The main aim of this study is to evaluate whether MR defecography can provide objective parameters correlating with the clinical manifestations of neurogenic bowel dysfunction (NBD) in participants with SCI. SETTING A monocentric study in a comprehensive care university hospital Spinal Cord Injury Center. METHODS Previously published MR defecography parameters (anorectal angle (ARA), hiatal descent (M-line) and hiatal width (H-line)) of twenty participants with SCI were now compared to a standardized clinical assessment of NBD. Descriptive statistics, correlations and t-tests for independent samples were calculated. RESULTS The significantly higher values for the ARA at rest and M-line at rest in participants with SCI correlated with the clinical assessment of bowel incontinence. Furthermore, in nearly half of the investigated SCI cohort the normally positive difference between ARA, M-line and H-line at rest and during defecation became negative suggesting pelvic floor dyssynergia as a potential mechanism underlying constipation in people with complete SCI. In fact, these participants showed a more severe clinical presentation of NBD according to the total NBD score. CONCLUSIONS MR defecography provides objective parameters correlating with clinical signs of NBD, such as constipation and bowel incontinence. Therefore, MR defecography can support pathophysiology-based decision-making with respect to specific therapeutic interventions, which should help to improve the management of NBD.
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Affiliation(s)
- Cornelia Putz
- Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Celine D Alt
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,University Duesseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, 40225, Duesseldorf, Germany
| | - Bjoern Wagner
- Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Simone Gantz
- Department of Experimental Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Hans J Gerner
- Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Lars Grenacher
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,Diagnostic Clinic Munich, Department of Radiology and Nuclear Medicine, Augustenstraße 115, 80798, Muenchen, Germany
| | - Cornelia Hensel
- Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
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Picchia S, Rengo M, Bellini D, Caruso D, Pironti E, Floris R, Laghi A. Dynamic MR of the pelvic floor: Influence of alternative methods to draw the pubococcygeal line (PCL) on the grading of pelvic floor descent. Eur J Radiol Open 2019; 6:187-191. [PMID: 31193423 PMCID: PMC6527906 DOI: 10.1016/j.ejro.2019.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/14/2019] [Indexed: 11/29/2022] Open
Abstract
Objective: To evaluate the impact of the pubococcygeal line (PCL) position on hiatal descent grading, comparing the method recommended by the official guidelines with the other two most common methods reported in literature. Methods: Female patients prospectively included performed dynamic-MR (1,5 T) in supine position. Rectum and vagina were filled with ultrasound gel. MR protocol included TSE T2 weighted sequences on axial/sagittal/coronal planes and steady-state sequences (FIESTA) on midsagittal plane during three phases (rest, strain and defecation). On each phase, the posterior point of PCL was traced in the region recommended by the official guidelines (last coccygeal joint or PCLcc) and in the other two regions: coccyx’s tip (PCLtip) and sacrococcygeal joint (PCLsc). The resulting grades of pelvic floor descent (according to HMO-System) were compared. Inter-reader and intra-reader agreement were evaluated. Results: The final population consisted of 60 patients (56yy±10). No significant differences in grading were observed using PCLtip and PCLcc in all phases (p = 0.3016/0.0719/0.0719 during rest/strain/defecation). Using PCLsc, the grading was significantly overestimated compared to PCLcc in all phases (p = 0.0041/0.0001/0.0001 during rest/strain/defecation). Inter-reader and intra-reader agreement were significantly higher using PCLtip (p < 0.05). Conclusions: PCLtip is a reliable and highly reproducible option to the official PCLcc to correctly grade the pelvic floor descent and could be used when the PCLcc is not clearly visible. The use of PCLsc overestimates the grading compared to the official PCLcc and should not be used to avoid wrong patients’ management.
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Key Words
- Defecography
- FIESTA, Fast Imaging Employing Steady-state Acquisition
- FOV, field of view
- Fecal incontinence
- Incontinence
- MR, magnetic Resonance
- Magnetic resonance
- Mcc, M line obtained by PCLcc
- Msc, M line obtained by PCLsc
- Mtip, M line obtained by PCLtip
- PCL, pubococcygeal line
- PCLcc, pubococcygeal line posterior point on the last coccygeal joint
- PCLsc, pubococcygeal line posterior point on the sacrococcygeal joint
- PCLtip, pubococcygeal line posterior point on the tip of the coccyx
- PFD, pelvic floor dysfunction
- Pelvic floor
- Pelvic pain
- STARD, Standards for Reporting of Diagnostic Accuracy
- TSE, turbo spin echo
- Urinary
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Affiliation(s)
- Simona Picchia
- Department of Radiological Sciences, Oncology and Pathology, "Sapienza" - University of Rome, Diagnostic Imaging Unit - I.C.O.T. Hospital, I.C.O.T, Via F. Faggiana 34, 04100 Latina, Italy
| | - Marco Rengo
- Department of Radiological Sciences, Oncology and Pathology, "Sapienza" - University of Rome, Diagnostic Imaging Unit - I.C.O.T. Hospital, I.C.O.T, Via F. Faggiana 34, 04100 Latina, Italy
| | - Davide Bellini
- Department of Radiological Sciences, Oncology and Pathology, "Sapienza" - University of Rome, Diagnostic Imaging Unit - I.C.O.T. Hospital, I.C.O.T, Via F. Faggiana 34, 04100 Latina, Italy
| | - Damiano Caruso
- Department of Radiological Sciences, Oncology and Pathology, "Sapienza" - University of Rome, Radiology Unit - Sant'Andrea University Hospital, Via di Grottarossa, 1035, 00189 Rome, Italy
| | - Eliseo Pironti
- Casa di Cura Privata Villa Benedetta Hospital, Circonvallazione Cornelia, 65, 00165, Rome, Italy
| | - Roberto Floris
- "Tor Vergata"- University of Rome. Department of Radiology - Tor Vergata Hospital, Viale Oxford, 81, 00133 Roma RM, Italy
| | - Andrea Laghi
- Department of Radiological Sciences, Oncology and Pathology, "Sapienza" - University of Rome, Radiology Unit - Sant'Andrea University Hospital, Via di Grottarossa, 1035, 00189 Rome, Italy
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Comparison of measurement systems for posterior vaginal wall prolapse on magnetic resonance imaging. Int Urogynecol J 2019; 30:1269-1277. [PMID: 30972442 DOI: 10.1007/s00192-019-03939-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 03/20/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS A wide variety of reference lines and landmarks have been used in imaging studies to diagnose and quantify posterior vaginal wall prolapse without consensus. We sought to determine which is the best system to (1) identify posterior vaginal wall prolapse and its appropriate cutoff values and (2) assess the prolapse size. METHODS This was a secondary analysis of sagittal maximal Valsalva dynamic MRI scans from 52 posterior-predominant prolapse cases and 60 comparable controls from ongoing research. All eight existing measurement lines and a new parameter, the exposed vaginal length, were measured. Expert opinions were used to score the prolapse sizes. Simple linear regressions, effect sizes, area under the curve, and classification and regression tree analyses were used to compare these reference systems and determine cutoff values. Linear and ordinal logistic regressions were used to assess the effectiveness of the prolapse size. RESULTS Among existing parameters, "the perineal line-internal pubis," a reference line from the inside of the pubic symphysis to the front tip of the perineal body (cutoff value 0.9 cm), had the largest effect size (1.61), showed the highest sensitivity and specificity to discriminate prolapse with area under the curve (0.91), and explained the most variation (68%) in prolapse size scores. The exposed vaginal length (cutoff value 2.9) outperformed all the existing lines, with the largest effect size (2.09), area under the curve (0.95), and R-squared value (0.77). CONCLUSIONS The exposed vaginal length performs slightly better than the best of the existing systems, for both diagnosing and quantifying posterior prolapse size. Performance characteristics and evidence-based cutoffs might be useful in clinical practice.
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Juliato CRT, Santos‐Junior LC, Castro EB, Dertkigil SS, Brito LGO. Vaginal axis after abdominal sacrocolpopexy versus vaginal sacrospinous fixation—a randomized trial. Neurourol Urodyn 2019; 38:1142-1151. [DOI: 10.1002/nau.23970] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/10/2019] [Accepted: 02/20/2019] [Indexed: 12/19/2022]
Affiliation(s)
| | - Luiz Carlos Santos‐Junior
- Department of Obstetrics and Gynecology, School of Medical SciencesUniversity of CampinasSão Paulo Brazil
| | - Edilson Benedito Castro
- Department of Obstetrics and Gynecology, School of Medical SciencesUniversity of CampinasSão Paulo Brazil
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Alt CD, Katzenberger SM, Hallscheidt P, Sohn C, Kauczor HU, Eickhoff SB, Brocker KA. Urethral length and bladder neck behavior: can dynamic magnetic resonance imaging give the same results as introital ultrasound? Arch Gynecol Obstet 2019; 299:809-816. [PMID: 30706182 DOI: 10.1007/s00404-019-05060-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/21/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare dynamic magnetic resonance imaging (dMRI) and introital ultrasound results with regard to urethral length measurements and the evaluation of bladder neck changes. METHODS Retrospective analyses of urethral length measurements and detection of bladder neck changes (rotated/vertical bladder neck descent, urethral funneling) were conducted in women-scheduled for surgical treatment with alloplastic material-who had undergone introital ultrasound and dMRI presurgery and 3 months postsurgery. Measurement differences between both imaging modalities were evaluated by assessing the confidence interval for the difference in means between the datasets using bootstrap analysis. RESULTS Based on data from 40 patients (320 image series), the urethra could be clearly measured on every pre- and postsurgical dMRI dataset but not on preoperative ultrasound images in nine women during Valsalva maneuver due to a large cystocele. The estimation of the mean difference distribution based on 500,000 bootstrap resamples indicated that the urethral length was measured shorter by dMRI pre- and postsurgery at rest and postsurgery during Valsalva maneuver (median 1.6-3.1 mm) but longer by dMRI (median 0.2 mm) during Valsalva maneuver presurgery. Rotated/vertical bladder neck descent and urethral funneling diagnoses showed concordance of 67-74% in the direct comparison of patients; the estimation of the concordance indicated poorer outcomes with 50-72%. CONCLUSIONS Metric information on urethral length from dMRI is comparable to that from introital ultrasound. dMRI is more advantageous in cases with an extended organ prolapse. At present, dMRI does not give the same diagnosis on bladder neck changes as introital ultrasound does.
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Affiliation(s)
- C D Alt
- Department of Diagnostic and Interventional Radiology, University Duesseldorf, Medical Faculty, Moorenstrasse 5, 40225, Duesseldorf, Germany
| | - S M Katzenberger
- Department of Obstetrics and Gynecology, Medical School, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.,Hannover Medical School, Clinic of Orthodontics, OE 7730, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - P Hallscheidt
- Department of Diagnostic and Interventional Radiology, University Heidelberg, Medical Faculty, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,Radiological Department Darmstadt, Academic Teaching Practice, University of Heidelberg Medical Center, Dieburger Str. 29-31, 64287, Darmstadt, Germany
| | - C Sohn
- Department of Obstetrics and Gynecology, Medical School, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - H U Kauczor
- Department of Diagnostic and Interventional Radiology, University Heidelberg, Medical Faculty, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - S B Eickhoff
- Institute of Neuroscience and Medicine (INM-7), Juelich Research Centre, 52428, Juelich, Germany.,Institute of Systems Neuroscience, Heinrich Heine University, 40225, Dusseldorf, Germany
| | - K A Brocker
- Department of Obstetrics and Gynecology, Medical School, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
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Abstract
Pelvic floor disorders (PFDs) are a common and complex problem encompassing a broad spectrum of conditions such as urinary incontinence, voiding difficulties, pelvic organ prolapse, anal incontinence, and chronic pelvic pain. The initial assessment of women with PFDs is based on a detailed and focused history and a holistic clinical evaluation of the pelvic floor. Other investigations may be used in clinical practice for the determination of the pathophysiology and the severity of the PFDs. In the field of urogynecology, urodynamic studies, ultrasound, and magnetic resonance imaging of the pelvic floor are currently implemented in the diagnostic work-up of women with PFDs. These provide valuable information not only on the anatomic integrity but also on the function of the pelvic floor which may not be apparent from the clinical examination. The provision of such information is complementary to the patient's symptoms and degree of bother and enables the implementation of a targeted treatment plan, thus maximizing the likelihood of cure and minimizing the risk of treatment complications.
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Affiliation(s)
- T Grigoriadis
- a Urogynecology Department , National and Kapodistrian University of Athens, 'Alexandra' Hospital , Athens , Greece
| | - S Athanasiou
- a Urogynecology Department , National and Kapodistrian University of Athens, 'Alexandra' Hospital , Athens , Greece
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30
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Gallo G, Martellucci J, Pellino G, Ghiselli R, Infantino A, Pucciani F, Trompetto M. Consensus Statement of the Italian Society of Colorectal Surgery (SICCR): management and treatment of complete rectal prolapse. Tech Coloproctol 2018; 22:919-931. [PMID: 30554284 DOI: 10.1007/s10151-018-1908-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 12/09/2018] [Indexed: 12/15/2022]
Abstract
Rectal prolapse, rectal procidentia, "complete" prolapse or "third-degree" prolapse is the full-thickness prolapse of the rectal wall through the anal canal and has a significant impact on quality of life. The incidence of rectal prolapse has been estimated to be approximately 2.5 per 100,000 inhabitants with a clear predominance among elderly women. The aim of this consensus statement was to provide evidence-based data to allow an individualized and appropriate management and treatment of complete rectal prolapse. The strategy used to search for evidence was based on application of electronic sources such as MEDLINE, PubMed, Cochrane Review Library, CINAHL and EMBASE. The recommendations were defined and graded based on the current levels of evidence and in accordance with the criteria adopted by the American College of Gastroenterology's Chronic Constipation Task Force. Five evidence levels were defined. The recommendations were graded A, B, and C.
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Affiliation(s)
- G Gallo
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy.,Department of Surgical and Medical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - J Martellucci
- Department of General, Emergency and Minimally Invasive Surgery, Careggi University Hospital, Florence, Italy
| | - G Pellino
- Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences, Unit of General Surgery, Università della Campania "Luigi Vanvitelli", Naples, Italy.,Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain
| | - R Ghiselli
- Department of General Surgery, Università Politecnica delle Marche, Ancona, Italy
| | - A Infantino
- Department of Surgery, Santa Maria dei Battuti Hospital, San Vito al Tagliamento, Pordenone, Italy
| | - F Pucciani
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - M Trompetto
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy.
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Arif-Tiwari H, Twiss CO, Lin FC, Funk JT, Vedantham S, Martin DR, Kalb BT. Improved Detection of Pelvic Organ Prolapse: Comparative Utility of Defecography Phase Sequence to Nondefecography Valsalva Maneuvers in Dynamic Pelvic Floor Magnetic Resonance Imaging. Curr Probl Diagn Radiol 2018; 48:342-347. [PMID: 30241870 DOI: 10.1067/j.cpradiol.2018.08.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 08/16/2018] [Accepted: 08/16/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate the utility of a defecography phase (DP) sequence in dynamic pelvic floor MRI (DPMRI), in comparison to DPMRI utilizing only non-defecography Valsalva maneuvers (VM). MATERIALS AND METHODS Inclusion criteria identified 237 female patients with symptoms and/or physical exam findings of pelvic floor prolapse. All DPMRI exams were obtained following insertion of ultrasound gel into the rectum and vagina. Steady-state free-precession sequences in sagittal plane were acquired in the resting state, followed by dynamic cine acquisitions during VM and DP. In all phases, two experienced radiologists performed blinded review using the H-line, M-line, Organ prolapse (HMO) system. The presence of a rectocele, enterocele and inferior descent of the anorectal junction, bladder base, and vaginal vault were recorded in all patients using the pubococcygeal line as a fixed landmark. RESULTS DPMRI with DP detected significantly more number of patients than VM (p<0.0001) with vaginal prolapse (231/237, 97.5% vs. 177/237, 74.7%), anorectal prolapse (227/237, 95.8% vs. 197/237, 83.1%), cystocele (197/237, 83.1% vs. 108/237, 45.6%), and rectocele (154/237, 65% vs. 93/237, 39.2%). The median cycstocele (3.2cm vs. 1cm), vaginal prolapse (3cm vs. 1.5cm), anorectal prolapse (5.4cm vs. 4.2cm), H-line (8cm vs. 7.2cm) and M-line (5.3cm vs. 3.9cm) were significantly higher with DP than VM (p<0.0001). CONCLUSIONS Addition of DP to DPMRI demonstrates a greater degree of pelvic floor instability as compared to imaging performed during VM alone. Pelvic floor structures may show mild descent or appear normal during VM, with marked prolapse on subsequent DP images.
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Affiliation(s)
- Hina Arif-Tiwari
- Department of Medical Imaging, University of Arizona, College of Medicine, Tucson, AZ; Department of Surgery, University of Arizona, Banner University Medicine, Tucson, AZ.
| | - Christian O Twiss
- Department of Surgery, Section of Urology, University of Arizona Medical Center, Tucson, AZ.
| | - Frank C Lin
- Division of Urology, Department of Surgery, University of Arizona, Banner University Medicine, Tucson, AZ.
| | - Joel T Funk
- Division of Urology, Department of Surgery, University of Arizona, Banner University Medicine, Tucson, AZ.
| | - Srinivasan Vedantham
- Department of Medical Imaging, University of Arizona, College of Medicine, Tucson, AZ.
| | - Diego R Martin
- College of Medicine, University of Arizona, Banner University Medicine, Tucson, AZ.
| | - Bobby T Kalb
- College of Medicine, University of Arizona, Tucson, AZ.
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Pizzoferrato AC, Fritel X. [Preoperative functional explorations of genital prolapse (urodynamics, dynamic MRI)]. ACTA ACUST UNITED AC 2018; 46:593-597. [PMID: 29997048 DOI: 10.1016/j.gofs.2018.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Indexed: 11/28/2022]
Abstract
The evaluation of genital prolapse is essentially clinical; however imaging tests such as dynamic MRI or urodynamic explorations may be useful in complex cases, especially before surgical management. Dynamic MRI allows morphological and dynamic analysis of pelvic floor and levator ani function. It can also detect post-obstetric injuries, although the long-term significance of these injuries remains to be discovered. Quantification of the severity of prolapse is possible with MRI; however, the correlation of these measures with clinical examination seems poor. Its interest lies mainly in the qualitative assessment of the three stages of prolapse and the detection of elytroceles, which can be difficult to clinical examination. Urodynamics provides useful information on vesico-sphincteric function, but none of these parameters seems to be decisive in the management of prolapse.
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Affiliation(s)
- A C Pizzoferrato
- Service de gynécologie-obstétrique, CHU de Caen, avenue Côte-de-Nacre, 14000 Caen, France.
| | - X Fritel
- Faculté de médecine et pharmacie, université de Poitiers, CIC1402, CESP, France
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Lin FC, Funk JT, Tiwari HA, Kalb BT, Twiss CO. Dynamic Pelvic Magnetic Resonance Imaging Evaluation of Pelvic Organ Prolapse Compared to Physical Examination Findings. Urology 2018; 119:49-54. [PMID: 29944912 DOI: 10.1016/j.urology.2018.05.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 05/17/2018] [Accepted: 05/22/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare dynamic magnetic resonance imaging (dMRI) defecography phase findings with physical examination (PE) grading in the evaluation of pelvic organ prolapse (POP). METHODS We retrospectively reviewed 274 consecutive patients who underwent dMRI with defecography. Baden-Walker grading of POP, absolute dMRI values, and grading by dMRI were collected for anterior, apical, and posterior compartments. Anatomically significant POP on PE was defined as Baden-Walker Grade ≥3 and on dMRI by dMRI Grade ≥2. A Spearman's Rank correlation was performed between absolute dMRI values and respective POP grades. RESULTS A total of 178 female patients were included. Anatomically insignificant and significant cystoceles had a 26.4% (19/72) and 84.6% (66/78) agreement respectively. Anatomically insignificant and significant apical prolapse had a 2.0% (2/100) and 62.9% (17/27) agreement respectively. Anatomically insignificant and significant posterior prolapse had a 49.5% (51/103) and 78.7% (59/75) agreement respectively. PE detected only 30% (9/30) of total dMRI detected enteroceles and misdiagnosed 10% (3/30) of these patients with a rectocele. CONCLUSION The dMRI defecography phase correlated well for anatomically significant prolapse in anterior and posterior compartments. dMRI was superior to PE for enterocele detection and was better able to distinguish an enterocele from a rectocele. Thus, dMRI may have the greatest diagnostic value in cases where the presence of an enterocele is unclear in apical and/or posterior compartments.
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Affiliation(s)
- Frank C Lin
- University of Arizona, College of Medicine, Division of Urology, Tucson, AZ.
| | - Joel T Funk
- University of Arizona, College of Medicine, Division of Urology, Tucson, AZ
| | - Hina Arif Tiwari
- University of Arizona, College of Medicine, Department of Medical Imaging, Tucson, AZ
| | - Bobby T Kalb
- University of Arizona, College of Medicine, Department of Medical Imaging, Tucson, AZ
| | - Christian O Twiss
- University of Arizona, College of Medicine, Division of Urology, Tucson, AZ
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Abdulaziz M, Kavanagh A, Stothers L, Macnab AJ. Relevance of open magnetic resonance imaging position (sitting and standing) to quantify pelvic organ prolapse in women. Can Urol Assoc J 2018; 12:E453-E460. [PMID: 29989885 DOI: 10.5489/cuaj.5186] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In pelvic organ prolapse (POP), posture and gravity impact organ position and symptom severity. The advanced magnet configuration in open magnetic resonance imaging (MRO) allows patients to be imaged when sitting and standing, as well in a conventional supine position. This study evaluated if sitting and standing MRO images are relevant as a means of improving quantification of POP because they allow differences in organ position not seen on supine imaging to be identified. METHODS Forty women recruited from a university urogynecology clinic had MRO imaging (0.5 T scanner) with axial and sagittal T2-weighted pelvic scans obtained when sitting, standing, and supine. Pelvic reference lines were used to quantify the degree of POP, and the relevance of imaging position on the detection of POP compared. RESULTS Images from 40 participants were evaluated (20 with POP and 20 asymptomatic controls). Our results indicate that the maximal extent of prolapse is best evaluated in the standing position using H line, M line, mid-pubic line, and perineal line as reference lines to determine POP. CONCLUSIONS MRO imaging of symptomatic patients in a standing position is relevant in the quantification of POP. Compared with supine images, standing imaging identifies that greater levels of downward movement in the anterior and posterior compartments occur, presumably under the influence of posture and gravity. In contrast, no appreciable benefit was afforded by imaging in the sitting position, which precluded use of some reference lines due to upward movement of the anorectal junction.
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Affiliation(s)
- Marwa Abdulaziz
- PhD Candidate, Department of Experimental Medicine, Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Alex Kavanagh
- Department of Urologic Sciences, University of British Columbia, and Principal Investigator, International Collaboration on Repair Discovery (ICORD), Blusson Spinal Cord Centre, Vancouver, BC, Canada
| | - Lynn Stothers
- Stellenbosch Institute for Advanced Study, Wallenberg Research Centre at Stellenbosch University, Stellenbosch, South Africa
| | - Andrew J Macnab
- Department of Urologic Sciences, University of British Columbia, and Principal Investigator, International Collaboration on Repair Discovery (ICORD), Blusson Spinal Cord Centre, Vancouver, BC, Canada.,Stellenbosch Institute for Advanced Study, Wallenberg Research Centre at Stellenbosch University, Stellenbosch, South Africa
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Nekooeimehr I, Lai-Yuen S, Bao P, Weitzenfeld A, Hart S. Automated contour tracking and trajectory classification of pelvic organs on dynamic MRI. J Med Imaging (Bellingham) 2018; 5:014008. [PMID: 29651450 DOI: 10.1117/1.jmi.5.1.014008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 03/12/2018] [Indexed: 11/14/2022] Open
Abstract
A method is presented to automatically track and segment pelvic organs on dynamic magnetic resonance imaging (MRI) followed by multiple-object trajectory classification to improve understanding of pelvic organ prolapse (POP). POP is a major health problem in women where pelvic floor organs fall from their normal position and bulge into the vagina. Dynamic MRI is presently used to analyze the organs' movements, providing complementary support for clinical examination. However, there is currently no automated or quantitative approach to measure the movement of the pelvic organs and their correlation with the severity of prolapse. In the proposed method, organs are first tracked and segmented using particle filters and [Formula: see text]-means clustering with prior information. Then, the trajectories of the pelvic organs are modeled using a coupled switched hidden Markov model to classify the severity of POP. Results demonstrate that the presented method can automatically track and segment pelvic organs with a Dice similarity index above 78% and Hausdorff distance of [Formula: see text] for 94 tested cases while demonstrating correlation between organ movement and POP. This work aims to enable automatic tracking and analysis of multiple deformable structures from images to improve understanding of medical disorders.
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Affiliation(s)
| | - Susana Lai-Yuen
- University of South Florida, Department of Industrial and Management Systems Engineering, Tampa, Florida, United States
| | - Paul Bao
- University of South Florida, Department of Computer Science and Engineering, Tampa, Florida, United States
| | - Alfredo Weitzenfeld
- University of South Florida, Department of Computer Science and Engineering, Tampa, Florida, United States
| | - Stuart Hart
- University of South Florida, Department of Obstetrics and Gynecology, Tampa, Florida, United States.,Medtronic, Tampa, Florida, United States
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Piloni V, Bergamasco M, Melara G, Garavello P. The clinical value of magnetic resonance defecography in males with obstructed defecation syndrome. Tech Coloproctol 2018; 22:179-190. [PMID: 29512048 DOI: 10.1007/s10151-018-1759-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 09/09/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND The aim of the present study was to assess the relationship between symptoms of obstructed defecation and findings on magnetic resonance (MR) defecography in males with obstructed defecation syndrome (ODS). METHODS Thirty-six males with ODS who underwent MR defecography at our institution between March 2013 and February 2016 were asked in a telephone interview about their symptoms and subsequent treatment, either medical or surgical. Patients were divided into 2 groups, one with anismus (Group 1) and one with prolapse without anismus (Group 2). The interaction between ODS type and symptoms with MR findings was assessed by multivariate analysis for categorical data using a hierarchical log-linear model. MR imaging findings included lateral and/or posterior rectocele, rectal prolapse, intussusception, ballooning of levator hiatus with impingement of pelvic organs and dyskinetic puborectalis muscle. RESULTS There were 21 males with ODS due to anismus (Group 1) and 15 with ODS due to rectal prolapse/intussusception (Group 2). Mean age of the entire group was 53.6 ± 4.1 years (range 18-77 years). Patients in Group 1 were slightly older than those in Group 2 (age peak, sixth decade in 47.6 vs 20.0%, p < 0.05). Symptoms most frequently associated with Group 1 patients included small volume and hard feces (85.0%, p < 0.01), excessive strain at stool (81.0%, p < 0.05), tenesmus and fecaloma formation (57.1 and 42.9%, p < 0.05); symptoms most frequently associated with Group 2 patients included mucous discharge, rectal bleeding and pain (86.7%, p < 0.05), prolonged toilet time (73.3%, p < 0.05), fragmented evacuation with or without digitation (66.7%, p < 0.005). Voiding outflow obstruction was more frequent in Group 1 (19.0 vs 13.3%; p < 0.05), while non-bacterial prostatitis and sexual dysfunction prevailed in Group 2 (26.7 and 46.7%, p < 0.05). At MR defecography, two major categories of findings were detected: a dyskinetic pattern (Type 1), seen in all Group 1 patients, which was characterized by non-relaxing puborectalis muscle, sand-glass configuration of the anorectum, poor emptying rate, limited pelvic floor descent and final residue ≥ 2/3; and a prolapsing pattern (Type 2), seen in all Group 2 patients, which was characterized by rectal prolapse/intussusception, ballooning of the levator hiatus with impingement of the rectal floor and prostatic base, excessive pelvic floor descent and residue ≤ 1/2. Posterolateral outpouching defined as perineal hernia was present in 28.6% of patients in Group 1 and were absent in Group 2. The average levator plate angle on straining differed significantly in the two patterns (21.3° ± 4.1 in Group 1 vs 65.6° ± 8.1 in Group 2; p < 0.05). Responses to the phone interview were obtained from 31 patients (18 of Group 1 and 13 of Group 2, response rate, 86.1%). Patients of Group 1 were always treated without surgery (i.e., biofeedback, dietary regimen, laxatives and/or enemas) which resulted in symptomatic improvement in 12/18 cases (66.6%). Of the patients in Group 2, 2/13 (15.3) underwent surgical repair, consisting of stapled transanal rectal resection (STARR) which resulted in symptom recurrence after 6 months and laparoscopic ventral rectopexy which resulted in symptom improvement. The other 11 patients of Group 2 were treated without surgery with symptoms improvement in 3 (27.3%). CONCLUSIONS The appearance of various abnormalities at MR defecography in men with ODS shows 2 distinct patterns which may have potential relevance for treatment planning, whether conservative or surgical.
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Affiliation(s)
- V Piloni
- Affidea - Diagnostic Imaging Centre, Monselice, Padova, Italy.
- , Ancona, Italy.
| | - M Bergamasco
- Affidea - Diagnostic Imaging Centre, Monselice, Padova, Italy
| | - G Melara
- Affidea - Diagnostic Imaging Centre, Monselice, Padova, Italy
| | - P Garavello
- Affidea - Diagnostic Imaging Centre, Monselice, Padova, Italy
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Piloni V, Bergamasco M, Melara G, Garavello P. The clinical value of magnetic resonance defecography in males with obstructed defecation syndrome. Tech Coloproctol 2018; 22:179-190. [DOI: 7) the clinical value of magnetic resonance defecography in males with obstructed defecation syndrome.v piloni, m.bergamasco, g.melara, p.garavello.techniques in coloproctology https:/doi.org/10.1007/s10151-018-1759-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 09/09/2017] [Indexed: 09/10/2023]
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Ramage L, Georgiou P, Qiu S, McLean P, Khan N, Kontnvounisios C, Tekkis P, Tan E. Can we correlate pelvic floor dysfunction severity on MR defecography with patient-reported symptom severity? Updates Surg 2017; 70:467-476. [PMID: 29255962 PMCID: PMC6244712 DOI: 10.1007/s13304-017-0506-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 12/02/2017] [Indexed: 12/15/2022]
Abstract
MR defecography (MRD) is an alternative to conventional defecography (CD) which allows for dynamic visualisation of the pelvic floor. The aim of this study was to assess whether MRI features indicative of pelvic floor dysfunction correlated with patient-reported symptom severity. MR proctograms were matched to a prospectively-maintained functional database. Univariate and multivariate analyses were performed using pre-treatment questionnaire responses to the Birmingham Bowel, Bladder and Urinary Symptom Questionnaire (BBUSQ), Wexner Incontinence Score (WIS), and modified Obstructed Defecation Symptom (ODS) Score. 302 MRI proctograms were performed between January 2012 and April 2015. 170 patients were included. Patients with a rectocele > 2 cm (p = 0.003; OR 5.756) or MRD features suggestive of puborectalis syndrome (p = 0.025; OR 8.602) were more likely to report a higher ODS score on multivariate analysis. Lack of rectal evacuation was negatively associated with an abnormal WIS (p = 0.007; OR 0.228). Age > 50 (p = 0.027, OR 2.204) and a history of pelvic floor surgery (p = 0.042, OR 0.359) were correlated with an abnormal BBUSQ incontinence score. Lack of rectal evacuation (p = 0.027, OR 3.602) was associated with an abnormal BBUSQ constipation score. Age > 50 (p = 0.07, OR 0.156) and the presence of rectoanal intussusception (p = 0.010, OR 0.138) were associated with an abnormal BBUSQ evacuation score. Whilst MRD is a useful tool in aiding multidisciplinary decision making, overall, it is poorly correlated with patient-reported symptom severity, and treatment decisions should not rest solely on results.
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Affiliation(s)
- Lisa Ramage
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust, Academic Surgery, 3rd Floor, Fulham Road, London, SW10 9NH, UK
| | - Panagiotis Georgiou
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust, Academic Surgery, 3rd Floor, Fulham Road, London, SW10 9NH, UK
| | - Shengyang Qiu
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust, Academic Surgery, 3rd Floor, Fulham Road, London, SW10 9NH, UK
| | - Paul McLean
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust, Academic Surgery, 3rd Floor, Fulham Road, London, SW10 9NH, UK
| | - Nasir Khan
- Department of Radiology, Chelsea Westminster Hospital, London, UK.,Department of Radiology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Christos Kontnvounisios
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust, Academic Surgery, 3rd Floor, Fulham Road, London, SW10 9NH, UK. .,Department of Colorectal Surgery, The Royal Marsden NHS Foundation Trust, London, UK.
| | - Paris Tekkis
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust, Academic Surgery, 3rd Floor, Fulham Road, London, SW10 9NH, UK.,Department of Colorectal Surgery, The Royal Marsden NHS Foundation Trust, London, UK
| | - Emile Tan
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Republic of Singapore
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Postoperative MR Defecography following Failed STARR Procedure for Obstructive Defecation Syndrome: A Three-Centre Experience. Gastroenterol Res Pract 2017; 2017:4392918. [PMID: 29158730 PMCID: PMC5660778 DOI: 10.1155/2017/4392918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/16/2017] [Accepted: 08/30/2017] [Indexed: 12/14/2022] Open
Abstract
Aim To describe the abnormalities at MR imaging and related complaints in patients with poor outcome after STARR procedure. Materials and Methods The medical records of 21 symptomatic patients from centre 1, 31 patients from centre 2, and 63 patients from centre 3 were reviewed with regard to findings at MR defecography and related symptoms. Results Regardless of the centre, most relevant imaging features and related complaints were (a) impaired emptying (82.11%), related complaint ODS; (b) persistent rectocele >2 cm and intussusception (39.3%), split evacuation and digitation; (c) pelvic organ descent on straining (39.8%), prolapse sensation; (d) small neorectum and loss of contrast (32.5%), urgency and incontinence; (e) anastomotic stricture and granuloma (28.4%), pain; and (f) nonrelaxing puborectalis muscle (19.5%), tenesmus. Less frequent findings included rectal pocket formation (5.6%) and rectovaginal sinus tract (1.6%). Patients were referred to MR imaging with an average time interval of 5 ± 2, 4 ± 1, and 2 ± 1 years in the three centres, respectively, and only rarely by the same surgeon who performed the operation: 1/21 (4.8%) in centre 1, 3/39 (7.7%) in centre 2, and 9/63 (14.3%) in centre 3. Conclusion Most surgeons involved in STARR operation with subsequent poor outcome do not rely on MR imaging.
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Chanda A, Meyer I, Richter HE, Lockhart ME, Moraes FRD, Unnikrishnan V. Vaginal Changes Due to Varying Degrees of Rectocele Prolapse: A Computational Study. J Biomech Eng 2017; 139:2644119. [PMID: 28696484 DOI: 10.1115/1.4037222] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Indexed: 12/25/2022]
Abstract
Pelvic organ prolapse (POP), downward descent of the pelvic organs resulting in a protrusion of the vagina, is a highly prevalent condition, responsible for 300,000 surgeries in the U.S. annually. Rectocele, a posterior vaginal wall (PVW) prolapse of the rectum, is the second most common type of POP after cystocele. A rectocele usually manifests itself along with other types of prolapse with multicompartment pelvic floor defects. To date, the specific mechanics of rectocele formation are poorly understood, which does not allow its early stage detection and progression prediction over time. Recently, with the advancement of imaging and computational modeling techniques, a plethora of finite element (FE) models have been developed to study vaginal prolapse from different perspectives and allow a better understanding of dynamic interactions of pelvic organs and their supporting structures. So far, most studies have focused on anterior vaginal prolapse (AVP) (or cystocele) and limited data exist on the role of pelvic muscles and ligaments on the development and progression of rectocele. In this work, a full-scale magnetic resonance imaging (MRI) based three-dimensional (3D) computational model of the female pelvic anatomy, comprising the vaginal canal, uterus, and rectum, was developed to study the effect of varying degrees (or sizes) of rectocele prolapse on the vaginal canal for the first time. Vaginal wall displacements and stresses generated due to the varying rectocele size and average abdominal pressures were estimated. Considering the direction pointing from anterior to posterior side of the pelvic system as the positive Y-direction, it was found that rectocele leads to negative Y-direction displacements, causing the vaginal cross section to shrink significantly at the lower half of the vaginal canal. Besides the negative Y displacements, the rectocele bulging was observed to push the PVW downward toward the vaginal hiatus, exhibiting the well-known "kneeling effect." Also, the stress field on the PVW was found to localize at the upper half of the vaginal canal and shift eventually to the lower half with increase in rectocele size. Additionally, clinical relevance and implications of the results were discussed.
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Affiliation(s)
- Arnab Chanda
- Department of Aerospace Engineering and Mechanics, University of Alabama, Tuscaloosa, AL 35487 e-mail:
| | - Isuzu Meyer
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 35233 e-mail:
| | - Holly E Richter
- J Marion Sims Professor of Obstetrics and Gynecology, Urology and Geriatrics Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 35233 e-mail:
| | - Mark E Lockhart
- Professor Diagnostic Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35233 e-mail:
| | - Fabia R D Moraes
- Department of Mechanical Engineering, Sao Paulo State University, Sao Paulo 01049, Brazil e-mail:
| | - Vinu Unnikrishnan
- Department of Aerospace Engineering and Mechanics, University of Alabama, Tuscaloosa, AL 35487 e-mail:
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Lockhart ME, Bates GW, Morgan DE, Beasley TM, Richter HE. Dynamic 3T pelvic floor magnetic resonance imaging in women progressing from the nulligravid to the primiparous state. Int Urogynecol J 2017; 29:735-744. [PMID: 28871385 DOI: 10.1007/s00192-017-3462-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/11/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to prospectively characterize dynamic pelvic 3-Tesla magnetic resonance imaging (dp3T MRI) findings in nulligravida women and characterize changes 6 months after delivery in the same woman. METHODS In this prospective study, nulligravida women seeking assisted reproductive technology for pregnancy were recruited. After physical examination by Pelvic Organ Prolapse Quantification (POP-Q), Brink assessment and measures including the Pelvic Floor Distress Inventory-20 and Pelvic Floor Impact Questionnaire-7, pre-pregnancy dp3T MRI at rest, with strain, and evacuation were performed. Assessments were repeated ≥6 months postpartum. Analysis included Welch and paired t tests for continuous variables, Fisher's exact test for differences in categorical outcomes, and paired t tests for postpartum symptoms. RESULTS Nineteen subjects (mean ± SD age, 31 ± 5 years) completed baseline clinical and dp3T MRI studies, 15 delivered and 10 (30.5 ± 3 years) completed pre-pregnancy and post-delivery clinical and dp3T MRI assessments. There were no significant changes in scores of validated questionnaires (all p > 0.05) or on POP-Q measures post-delivery. Two (20%) subjects without pre-pregnancy levator tears had tears on MRI post-delivery. MRI measures of pelvic organ descent were increased post-delivery. Seventeen pelvic soft-tissue parameters increased by greater than 10% post-delivery, including 5 out of 70 (7.1%), 17 out of 110 (15.5%), and 50 out of 110 (45.5%) values exceeding thresholds at rest, strain, and evacuation respectively. CONCLUSIONS Dynamic pelvic 3T MRI detected levator tears and increased pelvic organ descent, which can be directly attributed to pregnancy and delivery.
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Affiliation(s)
- Mark E Lockhart
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - G Wright Bates
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Desiree E Morgan
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Timothy M Beasley
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Holly E Richter
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA. .,Division Urogynecology and Pelvic Reconstructive Surgery, Department Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, 35249, USA.
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Khatri G, de Leon AD, Lockhart ME. MR Imaging of the Pelvic Floor. Magn Reson Imaging Clin N Am 2017; 25:457-480. [DOI: 10.1016/j.mric.2017.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Martín-Martín GP, García-Armengol J, Roig-Vila JV, Espí-Macías A, Martínez-Sanjuán V, Mínguez-Pérez M, Lorenzo-Liñán MÁ, Mulas-Fernández C, González-Argenté FX. Magnetic resonance defecography versus videodefecography in the study of obstructed defecation syndrome: Is videodefecography still the test of choice after 50 years? Tech Coloproctol 2017; 21:795-802. [DOI: 10.1007/s10151-017-1666-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 07/19/2017] [Indexed: 01/12/2023]
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Reiner CS, Williamson T, Winklehner T, Lisse S, Fink D, DeLancey JOL, Betschart C. The 3D Pelvic Inclination Correction System (PICS): A universally applicable coordinate system for isovolumetric imaging measurements, tested in women with pelvic organ prolapse (POP). Comput Med Imaging Graph 2017; 59:28-37. [PMID: 28609701 DOI: 10.1016/j.compmedimag.2017.05.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 05/19/2017] [Accepted: 05/30/2017] [Indexed: 01/03/2023]
Abstract
In pelvic organ prolapse (POP), the organs are pushed downward along the lines of gravity, so measurements along this longitudinal body axis are desirable. We propose a universally applicable 3D coordinate system that corrects for changes in pelvic inclination and that allows the localization of any point in the pelvis at rest or under dynamic conditions on magnetic resonance images (MRI) of pelvic floor disorders in a scanner- and software independent manner. The proposed 3D coordinate system called 3D Pelvic Inclination Correction System (PICS) is constructed utilizing four bony landmark points, with the origin set at the inferior pubic point, and three additional points at the sacrum (sacrococcygeal joint) and both ischial spines, which are clearly visible on MRI images. The feasibility and applicability of the moving frame was evaluated using MRI datasets from five women with pelvic organ prolapse, three undergoing static MRI and two undergoing dynamic MRI of the pelvic floor in a supine position. The construction of the coordinate system was performed utilizing the selected landmarks, with an initial implementation completed in MATLAB. In all cases the selected landmarks were clearly visible, with the construction of the 3D PICS and measurement of pelvic organ positions performed without difficulty. The resulting distance from the organ position to the horizontal PICS plane was compared to a traditional measure based on standard measurements in 2D slices. The two approaches demonstrated good agreement in each of the cases. The developed approach makes quantitative assessment of pelvic organ position in a physiologically relevant 3D coordinate system possible independent of pelvic movement relative to the scanner. It allows the accurate study of the physiologic range of organ location along the body axis ("up or down") as well as defects of the pelvic sidewall or birth-related pelvic floor injuries outside the midsagittal plane, not possible before in a 2D reference line system. Measures in 3D can be monitored over time and may reveal pathology before bothersome symptoms appear, as well as allowing comparison of outcomes between different patient pools after different surgical approaches.
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Affiliation(s)
- Caecilia S Reiner
- Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
| | | | | | - Sean Lisse
- Pelvic Floor Research Group, University of Michigan, Ann Arbor, MI, USA
| | - Daniel Fink
- University of Zurich, Zurich, Switzerland; Department of Gynecology, University Hospital of Zurich, Zurich, Switzerland
| | - John O L DeLancey
- Pelvic Floor Research Group, University of Michigan, Ann Arbor, MI, USA
| | - Cornelia Betschart
- University of Zurich, Zurich, Switzerland; Pelvic Floor Research Group, University of Michigan, Ann Arbor, MI, USA; Department of Gynecology, University Hospital of Zurich, Zurich, Switzerland.
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El Sayed RF, Alt CD, Maccioni F, Meissnitzer M, Masselli G, Manganaro L, Vinci V, Weishaupt D. Magnetic resonance imaging of pelvic floor dysfunction - joint recommendations of the ESUR and ESGAR Pelvic Floor Working Group. Eur Radiol 2017; 27:2067-2085. [PMID: 27488850 PMCID: PMC5374191 DOI: 10.1007/s00330-016-4471-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 05/03/2016] [Accepted: 05/11/2016] [Indexed: 12/05/2022]
Abstract
OBJECTIVE To develop recommendations that can be used as guidance for standardized approach regarding indications, patient preparation, sequences acquisition, interpretation and reporting of magnetic resonance imaging (MRI) for diagnosis and grading of pelvic floor dysfunction (PFD). METHODS The technique included critical literature between 1993 and 2013 and expert consensus about MRI protocols by the pelvic floor-imaging working group of the European Society of Urogenital Radiology (ESUR) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) from one Egyptian and seven European institutions. Data collection and analysis were achieved in 5 consecutive steps. Eighty-two items were scored to be eligible for further analysis and scaling. Agreement of at least 80 % was defined as consensus finding. RESULTS Consensus was reached for 88 % of 82 items. Recommended reporting template should include two main sections for measurements and grading. The pubococcygeal line (PCL) is recommended as the reference line to measure pelvic organ prolapse. The recommended grading scheme is the "Rule of three" for Pelvic Organ Prolapse (POP), while a rectocele and ARJ descent each has its specific grading system. CONCLUSION This literature review and expert consensus recommendations can be used as guidance for MR imaging and reporting of PFD. KEY POINTS • These recommendations highlight the most important prerequisites to obtain a diagnostic PFD-MRI. • Static, dynamic and evacuation sequences should be generally performed for PFD evaluation. • The recommendations were constructed through consensus among 13 radiologists from 8 institutions.
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Affiliation(s)
- Rania Farouk El Sayed
- Genitourinary & Pelvic Floor MR Imaging Unit, Department of Radiology, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt.
| | - Celine D Alt
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Duesseldorf, Germany
| | - Francesca Maccioni
- Department of Radiological Sciences, Oncology and Pathology Policlinico Umberto I Hospital, Sapienza University Rome, Viale Regina Elena, Rome, Italy
| | - Matthias Meissnitzer
- Department of Radiology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Gabriele Masselli
- Department of Radiology Dea, Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
| | - Lucia Manganaro
- Department of Radiological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena, Rome, Italy
| | - Valeria Vinci
- Department of Radiological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena, Rome, Italy
| | - Dominik Weishaupt
- Institute of Radiology and Nuclear Medicine, Triemli Hospital Zurich, Zurich, Switzerland
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Magnetic Resonance Imaging of Female Pelvic Floor Dysfunction: A Review of Dynamic MRI Defecography. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0217-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Putz C, Alt CD, Hensel C, Wagner B, Gantz S, Gerner HJ, Weidner N, Grenacher L. 3T MR-defecography-A feasibility study in sensorimotor complete spinal cord injured patients with neurogenic bowel dysfunction. Eur J Radiol 2017. [PMID: 28629562 DOI: 10.1016/j.ejrad.2017.02.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To investigate whether MR-defecography can be employed in sensorimotor complete spinal cord injury (SCI) subjects as a potential diagnostic tool to detect defecational disorders associated with neurogenic bowel dysfunction (NBD) using standard parameters for obstructed defecation. MATERIAL AND METHODS In a prospective single centre clinical trial, we developed MR-defecography in traumatic sensorimotor complete paraplegic SCI patients with upper motoneuron type injury (neurological level of injury T1 to T10) using a conventional 3T scanner. Defecation was successfully induced by eliciting the defecational reflex after rectal filling with ultrasonic gel, application of two lecicarbon suppositories and digital rectal stimulation. Examination was performed with patients in left lateral decubitus position using T2-weighted turbo spin echo sequence in the sagittal plane at rest (TE 89ms, TR 3220ms, FOV 300mm, matrix 512×512, ST 4mm) and ultrafast-T2-weighted-sequence in the sagittal plane with repeating measurements (TE 1.54ms, TR 3.51ms, FOV 400mm, matrix 256×256, ST 6mm). Changes of anorectal angle (ARA), anorectal descent (ARJ) and pelvic floor weakness were documented and measured data was compared to reference values of asymptomatic non-SCI subjects in the literature to assess feasibility. RESULTS MR-defecography provides evaluable imaging sequences of the induced evacuation phase in SCI patients. Measurement results for ARA, ARJ, hiatal width (H-line) and hiatal descent (M-line) deviate significantly from reference values in the literature in asymptomatic subjects without SCI. The overall mean values in our study for SCI patients were: ARA (rest) 127.3°, ARA (evacuation) 137.6°, ARJ (rest) 2.4cm, ARJ (evacuation) 4.0cm, H-line (rest) 7.6cm, H-line (evacuation) 8.1cm, M-line (rest) 2.6cm, M-line (evacuation) 4.2cm. CONCLUSIONS MR-defecography is feasible in sensorimotor complete SCI patients. Individual MR-defecography findings may help to determine specific therapeutical options for respective patients suffering from severe NBD.
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Affiliation(s)
- Cornelia Putz
- Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
| | - Celine D Alt
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
| | - Cornelia Hensel
- Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
| | - Björn Wagner
- Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
| | - Simone Gantz
- Department of Experimental Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
| | - Hans-Jürgen Gerner
- Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
| | - Lars Grenacher
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
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Piloni V, Possanzini M, Bergamasco M, Santi G. Postoperative MR Defecography following Failed STARR Procedure for Obstructive Defecation Syndrome: A Three-Centre Experience. Gastroenterol Res Pract 2017; 2017:1-8. [DOI: vittorio piloni, marco possanzini, mattia bergamasco, and gianluca santi.gastroenterology research and practice 2017, article id 4392918, https:/doi.org/10.1155/2017/4392918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/10/2023] Open
Abstract
Aim. To describe the abnormalities at MR imaging and related complaints in patients with poor outcome after STARR procedure. Materials and Methods. The medical records of 21 symptomatic patients from centre 1, 31 patients from centre 2, and 63 patients from centre 3 were reviewed with regard to findings at MR defecography and related symptoms. Results. Regardless of the centre, most relevant imaging features and related complaints were (a) impaired emptying (82.11%), related complaint ODS; (b) persistent rectocele >2 cm and intussusception (39.3%), split evacuation and digitation; (c) pelvic organ descent on straining (39.8%), prolapse sensation; (d) small neorectum and loss of contrast (32.5%), urgency and incontinence; (e) anastomotic stricture and granuloma (28.4%), pain; and (f) nonrelaxing puborectalis muscle (19.5%), tenesmus. Less frequent findings included rectal pocket formation (5.6%) and rectovaginal sinus tract (1.6%). Patients were referred to MR imaging with an average time interval of 5 ± 2, 4 ± 1, and 2 ± 1 years in the three centres, respectively, and only rarely by the same surgeon who performed the operation: 1/21 (4.8%) in centre 1, 3/39 (7.7%) in centre 2, and 9/63 (14.3%) in centre 3. Conclusion. Most surgeons involved in STARR operation with subsequent poor outcome do not rely on MR imaging.
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Affiliation(s)
- Vittorio Piloni
- Radiologist Diagnostic Imaging Centre, Iniziativa Medica, Monselice, Padua, Italy
| | - Marco Possanzini
- Technician Diagnostic Imaging Centre, Villa Igea Clinic, Ancona, Italy
| | - Mattia Bergamasco
- Technician Diagnostic Imaging Centre, Iniziativa Medica, Monselice, Padua, Italy
| | - Gianluca Santi
- Technician Diagnostic Imaging Centre, Studio Ronconi, Acilia, Rome, Italy
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Payne I, Grimm LM. Functional Disorders of Constipation: Paradoxical Puborectalis Contraction and Increased Perineal Descent. Clin Colon Rectal Surg 2016; 30:22-29. [PMID: 28144209 DOI: 10.1055/s-0036-1593430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Paradoxical puborectalis contraction (PPC) and increased perineal descent (IPD) are subclasses of obstructive defecation. Often these conditions coexist, which can make the evaluation, workup, and treatment difficult. After a thorough history and examination, workup begins with utilization of proven diagnostic modalities such as cinedefecography and anal manometry. Advancements in technology have increased the surgeon's diagnostic armamentarium. Biofeedback and pelvic floor therapy have proven efficacy for both conditions as first-line treatment. In circumstances where PPC is refractory to biofeedback therapy, botulinum toxin injection is recommended. Historically, pelvic floor repair has been met with suboptimal results. In IPD, surgical therapy now is directed toward the potentially attendant abnormalities such as rectoanal intussusception and rectal prolapse. When these associated abnormalities are not present, an ostomy should be considered in patients with IPD as well as medically refractory PPC.
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Affiliation(s)
- Isaac Payne
- Department of Surgery, University of South Alabama Medical Center, Mobile, Alabama
| | - Leander M Grimm
- Division of Colon & Rectal Surgery, Department of Surgery, University of South Alabama, Mobile, Alabama
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Mäkelä-Kaikkonen JK, Rautio TT, Koivurova S, Pääkkö E, Ohtonen P, Biancari F, Mäkelä JT. Anatomical and functional changes to the pelvic floor after robotic versus laparoscopic ventral rectopexy: a randomised study. Int Urogynecol J 2016; 27:1837-1845. [DOI: 10.1007/s00192-016-3048-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/10/2016] [Indexed: 12/14/2022]
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