Do ultrasound findings of levator ani “avulsion” correlate with anatomical findings: A multicenter cadaveric study

Silva, Ana Sofia Da; Digesu, G. Alessandro; Dell'Utri, Chiara; Fritsch, Helga; Piffarotti, Paola; Khullar, Vik

doi:10.1002/nau.22781

Cited by 17 publications

(14 citation statements)

References 32 publications

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“…This selection could introduce bias into the CNN, challenging the development of such a method capable of dealing with avulsions, based on these limited data. Avulsion of the PRM influences its appearance on TPUS and there is no complete agreement between experts on the appearance of avulsions. Therefore, we decided to focus on the intact pelvic floor by including only the data of nulliparae in our training set.…”

Section: Discussionmentioning

confidence: 99%

Deep learning enables automatic quantitative assessment of puborectalis muscle and urogenital hiatus in plane of minimal hiatal dimensions

Noort

Vaart

Grob

et al. 2019

Ultrasound in Obstet & Gyne

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Objectives To measure the length, width and area of the urogenital hiatus (UH), and the length and mean echogenicity (MEP) of the puborectalis muscle (PRM), automatically and observer‐independently, in the plane of minimal hiatal dimensions on transperineal ultrasound (TPUS) images, by automatic segmentation of the UH and the PRM using deep learning. Methods In 1318 three‐ and four‐dimensional (3D/4D) TPUS volume datasets from 253 nulliparae at 12 and 36 weeks' gestation, two‐dimensional (2D) images in the plane of minimal hiatal dimensions with the PRM at rest, on maximum contraction and on maximum Valsalva maneuver, were obtained manually and the UH and PRM were segmented manually. In total, 713 of the images were used to train a convolutional neural network (CNN) to segment automatically the UH and PRM in the plane of minimal hiatal dimensions. In the remainder of the dataset (test set 1 (TS1); 601 images, four having been excluded), the performance of the CNN was evaluated by comparing automatic and manual segmentations. The performance of the CNN was also tested on 117 images from an independent dataset (test set 2 (TS2); two images having been excluded) from 40 nulliparae at 12 weeks' gestation, which were acquired and segmented manually by a different observer. The success of automatic segmentation was assessed visually. Based on the CNN segmentations, the following clinically relevant parameters were measured: the length, width and area of the UH, the length of the PRM and MEP. The overlap (Dice similarity index (DSI)) and surface distance (mean absolute distance (MAD) and Hausdorff distance (HDD)) between manual and CNN segmentations were measured to investigate their similarity. For the measured clinically relevant parameters, the intraclass correlation coefficients (ICCs) between manual and CNN results were determined. Results Fully automatic CNN segmentation was successful in 99.0% and 93.2% of images in TS1 and TS2, respectively. DSI, MAD and HDD showed good overlap and distance between manual and CNN segmentations in both test sets. This was reflected in the respective ICC values in TS1 and TS2 for the length (0.96 and 0.95), width (0.77 and 0.87) and area (0.96 and 0.91) of the UH, the length of the PRM (0.87 and 0.73) and MEP (0.95 and 0.97), which showed good to very good agreement. Conclusion Deep learning can be used to segment automatically and reliably the PRM and UH on 2D ultrasound images of the nulliparous pelvic floor in the plane of minimal hiatal dimensions. These segmentations can be used to measure reliably UH dimensions as well as PRM length and MEP. © 2018 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

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Section: Discussionmentioning

confidence: 99%

Deep learning enables automatic quantitative assessment of puborectalis muscle and urogenital hiatus in plane of minimal hiatal dimensions

Noort

Vaart

Grob

et al. 2019

Ultrasound in Obstet & Gyne

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“…Several factors may explain our findings showing the association between menopause and defective involuntary PFM contraction. Impaired PFM contractions during sudden increases in the intra‐abdominal pressure may relate to levator avulsion or attenuation, which is linked to weaker pelvic support represented in the postmenopausal women in the present study. Weaker PFM contractions may also be associated with reductions in the vascularization and volume of the levator ani muscle as well as increased noncontractile tissue (intramuscular fat) after menopause.…”

Section: Discussionmentioning

confidence: 99%

Menopause is associated with impaired responsiveness of involuntary pelvic floor muscle contractions to sudden intra‐abdominal pressure rise in women with pelvic floor symptoms: A retrospective study

Huang

Yang

2017

Neurourology and Urodynamics

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“…In this paper we have found that “avulsions” are associated with a narrowing of the PVM attachment depth . This may be the anatomical finding which is visible on MRI 28 , in delivery suite 29 , in the operating theatre and on clinical examination .…”

mentioning

confidence: 63%

“…There was 100% (perfect) agreement for the presence or absence of an anatomical “avulsion”. In fact, there was not a single ultrasonographically observed “avulsion” seen on anatomical dissection …”

mentioning

confidence: 99%

Authors’ response re: Shek KL & Dietz H. Letter to the Editor Re: ‘Do ultrasound findings of levator ani “Avulsion” correlate with anatomical findings: A multicenter cadaveric study’

Silva¹,

Digesu²,

Dell'Utri³

et al. 2015

Neurourology and Urodynamics

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Do ultrasound findings of levator ani “avulsion” correlate with anatomical findings: A multicenter cadaveric study

Cited by 17 publications

References 32 publications

Deep learning enables automatic quantitative assessment of puborectalis muscle and urogenital hiatus in plane of minimal hiatal dimensions

Deep learning enables automatic quantitative assessment of puborectalis muscle and urogenital hiatus in plane of minimal hiatal dimensions

Menopause is associated with impaired responsiveness of involuntary pelvic floor muscle contractions to sudden intra‐abdominal pressure rise in women with pelvic floor symptoms: A retrospective study

Authors’ response re: Shek KL & Dietz H. Letter to the Editor Re: ‘Do ultrasound findings of levator ani “Avulsion” correlate with anatomical findings: A multicenter cadaveric study’

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