Dynamic magnetic resonance imaging of the female pelvic floor—a pictorial review

Abstract

Pelvic floor dysfunctions represent a range of functional disorders that frequently occur in adult women, carrying a significant burden on the quality of life, and its incidence tends to increase attending to the expected aging of the population. Pelvic floor dysfunctions can manifest as incontinence, constipation, and prolapsed pelvic organs. Since pelvic floor weakness is frequently generalized and clinically underdiagnosed, imaging evaluation is of major importance, especially prior to surgical correction. Given some interobserver variability of soft-tissue measurements, MR defecography allows a noninvasive, radiation-free, multiplanar dynamic evaluation of the three pelvic compartments simultaneously and with high spatial and temporal resolution. Both static/anatomic and dynamic/functional findings are important, since pelvic disorders can manifest as whole pelvic floor weakness/dysfunction or as an isolated or single compartment disorder. Imaging has a preponderant role in accessing pelvic floor disorders, and dynamic MR defecography presents as a reliable option, being able to evaluate the entire pelvic floor for optimal patient management before surgery. The purpose of this article is to address the female pelvic anatomy and explain the appropriate MR Defecography protocol, along with all the anatomic points, lines, angles, and measurements needed for a correct interpretation, to later focus on the different disorders of the female pelvic floor, illustrated with MR defecography images, highlighting the role of this technique in accessing these pathologic conditions.

The Most Common Functional Disorders and Factors Affecting Female Pelvic Floor

“…However, as PFM, PF ligaments, and fascia are functionally connected, dysfunction in these usually affects the entire PF, while symptoms in one compartment may be more severe than in others [26]. The common causes of PFD are weakness, damage in the supporting structures, and incorrect functioning of PFM [27].…”

“…Anterior compartment disorders are primarily caused by the lowering of the anterior vaginal wall due to its pushing through the bladder and by urethral hypermobility [27]. The etiology of anterior compartment disorders is unclear, but all the proposed theories suggest that these disorders are related to the weakening of myofascial support [11].…”

Defecografía por resonancia magnética y su utilidad en el estudio de disfunción del piso pélvico

“…En la D-RM, esta patología se manifiesta como hipertrofia del puborrectal, retardo entre la apertura del canal anal y la defecación, falta de descenso de la pelvis y contracción paradójica del puborrectal con reducida apertura del ángulo ano-rectal, determinando una evacuación prolongada o incompleta (Figura 10). Es frecuente la asociación al rectocele anterior 18 . Es fundamental un diagnóstico adecuado de esta patología, ya que se maneja clínicamente con bio-feedback.…”

Detectability of pulmonary ossifications in fibrotic lung on ultra-high-resolution CT using 2048 matrix size and 0.25-mm slice thickness

“…Ultra-high-resolution CT (UHRCT) scanners with 0.25 × 0.25 mm detector elements and beam collimation of 0.25 mm × 160 rows have recently become available in clinical practice 9 – 14 . This system can provide images with matrix size as large as 2048 × 2048 and slice thickness of 0.25 mm, which greatly increase resolution in the x–y axes and z axis 11 .…”