PurposeThe purpose of this study was to investigate magnetic resonance imaging (MRI) and 3-dimensional transperineal ultrasound (3D-TPUS) features of pelvic floor dysfunction (PFD) in symptomatic women in correlation with digital palpation and to define cut-offs for hiatal dimensions predictive of muscle dysfunction.MethodsThis prospective study included 73 women with symptoms suggesting PFD. 3D-TPUS, MRI, and digital palpation of the levator ani muscle were performed in all patients. Levator hiatal antero-posterior (LHap) diameter and area (LH area) were measured at rest and at maximum muscle contraction.ResultsThe reduction in LHap diameter and LH area during contraction was significantly less in women with underactive pelvic floor muscle contraction (UpfmC) than in those who had normal pelvic floor muscle contraction by digital palpation (P<0.001). Statistically significant positive correlations (P<0.001) were found between the Modified Oxford Score and 3D-TPUS and MRI regarding the reduction in the LHap diameter (r=0.80 and r=0.82, respectively) and LH area (r=0.60 and r=0.70, respectively). A reduction in LHap of <6.5% on 3D-TPUS and <7.6% on MRI predicted UpfmC with sensitivities of 46.2% and 82.7%, respectively. A reduction in LH area of <3.4% on 3D-TPUS and <3.8% on MRI predicted UpfmC with sensitivities of 75.0% and 88.5%, respectively. MRI was more sensitive in detecting levator avulsion (63.4%) than 3D-TPUS (27.1%).ConclusionMRI and 3D-TPUS had strong positive correlations with findings on palpation, and at certain cut-offs for hiatal dimensions, they can be used as complementary and objective tools to improve the accuracy of diagnosis and management planning of PFD.

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Objective: To compare the diagnostic potential of magnetic resonance imaging (MRI), three dimensional (3D) hysterosonography and diagnostic hysteroscopy in evaluation of the uterine cavity in women with premenopausal and postmenopausal bleeding.Design: Comparative study. Setting: Zagazig University hospital. Materials and methods: 30 patients with premenopausal bleeding and 30 patients with postmenopausal bleeding scheduled for hysterectomy were submitted to MRI, 3D hysterosonography and hysteroscopy to evaluate the endometrial cavity. Results were compared with histopathologic examination at hysterectomy (the gold standard).Results: In the premenopausal group; the sensitivity of MRI was 71.43%, 3D hysterosonography 85.71% and hysteroscopy 80.95%, the specificity of MRI was 55.56%, 3D hysterosonography 66.67% and hysteroscopy 88.89% and the degree of agreement with histopathology was 0.47 for MRI, 0.65 for 3D hysterosonography and 0.73 for hysteroscopy (P = .000, 0.000 and 0.000, respectively). In the postmenopausal group; the sensitivity of MRI was 88.24%, 3D hysterosonography 88.24% and hysteroscopy 88.24%, the specificity of MRI was 69.23%, 3D hysterosonography 84.61% and hysteroscopy 84.61% and the degree of agreement with histopathology was 0.60 for MRI, 0.72 for 3D hysterosonography and 0.73 for hysteroscopy (P = .000, 0.000 and 0.000, respectively) and for both groups; the sensitivity of MRI was 78.75%, 3D hysterosonography 86.84% and hysteroscopy 84.21%, the specificity of MRI was 63.64%, 3D hysterosonography 77.27% and * Corresponding author. Address: