Diagnostic Value of Dynamic Magnetic Resonance Imaging (dMRI) of the Pelvic Floor in Genital Prolapses

Advancements in Magnetic Resonance Imaging for the Evaluation of Pelvic Organ Prolapse: A Comprehensive Review

Pelvic organ prolapse (POP) is a major health issue for women, making accurate diagnosis and assessment essential for effective clinical management. Among the various imaging techniques used for POP evaluation, translabial ultrasound and fluoroscopy have been widely utilized. Translabial ultrasound is a non-invasive, cost-effective method that provides real-time dynamic imaging of the pelvic floor during activities such as straining. Fluoroscopy, often employed in defecography, offers real-time visualization of pelvic organ movement but is limited by radiation exposure. Magnetic resonance imaging (MRI), with its superior soft tissue contrast and non-invasive nature, has emerged as a valuable tool for providing detailed anatomical and functional insights into POP This review outlines the advancements in using MRI to assess POP. It highlights the technical advantages, clinical applications, comparisons with other imaging methods, and future research directions. By analyzing recent research, we aim to clarify the role of MRI in evaluating POP and encourage its integration into clinical practice.

Assessment of Different Pubococcygeal Lines for the Quantitative Diagnosis of Pelvic Organ Prolapse Using Magnetic Resonance Defecography

INTRODUCTION AND HYPOTHESIS

The objective was to elucidate the clinical utility of two reference lines, the pubosacrococcygeal joint line (PCLjnt) and pubococcygeal joint line (PCLcc), in the quantitative diagnosis of pelvic organ prolapse (POP) and pelvic floor laxity.

METHODS

A retrospective analysis of magnetic resonance defecography (MRD) in patients with stage II or above POP was conducted. POP and pelvic floor relaxation were quantitatively assessed using both PCLjnt and PCLcc as reference lines. Further research, point-to-point correlation analysis was performed between the pelvic organ prolapse quantification (POP-Q) system and MRD to investigate the discrepancies between the two reference lines.

RESULTS

There was no significant statistical difference in the degree of cystocele and H line between the PCLjnt and PCLcc groups (p > 0.05). Nevertheless, significant differences in the degree of uterine prolapse and M-line between the two groups were observed (p = 0.00). Both the PCLjnt and PCLcc reference lines demonstrated better correlation with POP-Q, and the PCLcc exhibited slightly higher correlation coefficients than the PCLjnt.

CONCLUSIONS

The results revealed significant moderate correlations between both reference lines and key POP-Q landmarks. Both PCLjnt and PCLcc can be utilized for interpreting MRD images and diagnosing POP for anterior wall and uterine prolapse.

Comparison of Dynamic Magnetic Resonance Defecography With Clinical Examination in Diagnosing Pelvic Floor Dysfunction: An Observational Study

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.