All participants provided informed consent to participate in this study, which was approved by the institutional review board. Breath-hold three-dimensional (3D) steady-state free precession (SSFP) magnetic resonance (MR) angiography was compared with 3D contrast material-enhanced MR angiography in patients suspected of having renal artery stenosis. Two radiologists assessed visualization of renal arteries and detection of vascular disease. With SSFP MR angiography, 39 of 41 renal arteries in 19 patients were correctly detected. Relevant stenoses were correctly identified with SSFP MR angiography in two patients. In two patients, SSFP MR angiographic data sets led to false-positive overgrading of vascular disease. Fast breath-hold 3D SSFP MR angiography appears to be feasible for MR angiography of renal arteries.
Introduction and hypothesis The objective of this study was to measure the effects of pregnancy and parturition on pelvic floor muscles and pelvic organ support. Methods Levator ani, obturator internus, and coccygeus (COC) muscle volumes and contrast uptake were assessed by MRI of seven females prior to pregnancy, 3 days, and 4 months postpartum. Bladder neck and cervix position were measured dynamically with abdominal squeezing. Results The sides of three paired muscles were similar (p>0.66). COC volumes were greater (p<0.004) after parturition than before pregnancy or after recovery. COC contrast uptake increased (p<0.02) immediately after delivery. Bladder neck position both in the relaxed state and abdominal pressure descended (p<0.04) after delivery and descended further (p<0.001) after recovery. Cervical position in the relaxed state before delivery was higher (p<0.001) than postpartum but was unchanged (p=0.50) with abdominal pressure relative to delivery. Conclusion In squirrel monkeys, coccygeus muscles demonstrate the greatest change related to parturition, and parturition-related bladder neck descent seems permanent.
Objectives Vaginal delivery is a risk factor in pelvic floor disorders. We previously described changes in the pelvic floor associated with pregnancy and parturition in the squirrel monkey, a species with a human-like pattern of spontaneous age and parity associated pelvic organ prolapse. The potential to prevent or diminish these changes with scheduled cesarean section has not been evaluated. In a randomized, controlled trial, we compare female squirrel monkeys undergoing spontaneous vaginal delivery with those undergoing scheduled primary cesarean section for pelvic floor muscle volumes, muscle contrast changes, and dynamic effects on bladder neck position. Study Design Levator ani, obturator internus, and coccygeus muscle volumes and contrast uptake were assessed by magnetic resonance imaging in 20 nulliparous females examined prior to pregnancy, a few days after delivery, and 3 months post-partum. The position of bladder neck relative to boney reference line also was assessed with abdominal pressure using dynamic magnetic resonance imaging. Results Baseline measurements of 10 females randomly assigned to scheduled primary cesarean sections were not different from those of 10 females assigned to spontaneous vaginal delivery. Levator ani and obturator internus muscle volumes did not differ between groups, while volumes were reduced (p < 0.05) in the observation immediately after pregnancy. The coccygeus muscles increased (p < 0.05) immediately after delivery for females in the spontaneous vaginal delivery group, but not for females in the scheduled cesarean section group. Position of the bladder neck descended (p < 0.05) by 3 months post-partum in both groups. Conclusions Scheduled cesarean delivery diminishes changes in coccygeus muscle volume and contrast reported to be associated with spontaneous vaginal delivery in squirrel monkeys. However, pelvic support of the bladder was not protected by this intervention suggesting that effects of pregnancy and delivery are not uniformly prevented by this procedure.
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