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Purpose:To assess the reproducibility of bone and soft-tissue pelvimetry measurements obtained from dynamic magnetic resonance (MR) imaging studies in primiparous women across multiple centers. Materials and Methods:All subjects prospectively gave consent for participation in this institutional review board-approved, HIPAA-compliant study. At six clinical sites, standardized dynamic pelvic 1.5-T multiplanar T2-weighted MR imaging was performed in three groups of primiparous women at 6 -12 months after birth: Group 1, vaginal delivery with anal sphincter tear (n ϭ 93); group 2, vaginal delivery without anal sphincter tear (n ϭ 79); and group 3, cesarean delivery without labor (n ϭ 26). After standardized central training, blinded readers at separate clinical sites and a blinded expert central reader measured nine bone and 10 soft-tissue pelvimetry parameters. Subsequently, three readers underwent additional standardized training, and reread 20 MR imaging studies. Measurement variability was assessed by using intraclass correlation for agreement between the clinical site and central readers. Acceptable agreement was defined as an intraclass correlation coefficient (ICC) of at least 0.7. Results:There was acceptable agreement (ICC range, Note: This copy is for your personal, non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, use the Radiology Reprints form at the end of this article. Pelvic floor symptoms are common in women after childbirth (1). Objective assessment of anatomic changes and structural pathologic indicators is an important adjunct in characterization of pelvic floor symptoms resulting from childbirth. Dynamic magnetic resonance (MR) imaging is used to assess pelvic organ prolapse (2-5); however, correlation of MR findings with physical examination and cystocolpoproctography results is variable (5-7). Defecography also has high interobserver variability (8). Measurement reproducibility is important to assess, whether in the research or the clinical setting, since it may affect management of patients with pelvic floor disorders.Previously, a few small single-center series or retrospective studies have shown variable interobserver reliability in characterizing specific anatomic findings of anal sphincter and pelvic structures demonstrated by using MR imaging (9-14). Intraobserver correlation of pelvic organ prolapse has been weak even in single-site studies (12). Moderate and moderate-to-good interobserver correlation of external anal sphincter atrophy on endoanal ( ϭ 0.53-0.56) and phased-array coil ( ϭ 0.55-0.80) MR imaging have been reported (15). Better interobserver correlation has been shown in other singlecenter studies (10,11). Beets-Tan et al (10) showed better interobserver correlation for the internal anal sphincter by using endoanal (intraclass correlation coefficient [ICC], 0.65) and phasedarray (ICC, 0.75) MR imaging. Keller et al (11) showed high interobserver correlation for bone measurements such as obstetric conjugate (ICC, 0.96...

Introduction and Hypothesis-To compare pelvic anatomy, using magnetic resonance imaging (MRI), between women with or without pelvic floor disorders 6-12 months after a first delivery.

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The anatomy of the pelvic floor is complex and difficult to visualize from conventional two-dimensional anatomy pictures. The goal of this project was to establish the methods necessary to develop a static three-dimensional virtual reality model of the normal female pelvic floor from high-resolution magnetic resonance imaging (MRI) scans. An asymptomatic nulliparous 23-year-old female with no urinary incontinence symptoms underwent a high-resolution pelvic floor MRI scan. Selected pelvic floor structures were manually segmented: bladder, urethra, vagina, uterus, cervix, levator ani, obturator externus, obturator internus, and pubic bone. With high-resolution scans, accurate segmentation of the structures was possible. The completed models were displayed on an ImmersaDesk Virtual Reality system and three clinicians verified their accuracy. Stereovision glasses were used to enhance the model while a receiver tracked head position. Three-dimensional virtual reality models of the female pelvic floor can enhance our understanding of anatomy and physiology of this complex part of the body. They can be used as tools for both research and teaching, facilitating improved treatment of pelvic floor pathologies.

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