Erratum to: Prospective Comparison between two different magnetic resonance defecography techniques for evaluating pelvic floor disorders: air-balloon versus gel for rectal filling

Maccioni, Francesca; Ansari, Najwa Al; Buonocore, Valeria; Mazzamurro, Fabrizio; Indinnimeo, M; Mongardini, Massimo; Catalano, Carlo

doi:10.1007/s00330-016-4489-x

Cited by 2 publications

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“…For over 25 years, since its early clinical introduction, dynamic MRI for the evaluation of pelvic floor dysfunction has been performed with extremely heterogeneous techniques due to the variability of patient preparation, MRI equipments, and image evaluation systems [10,11]. Recently a standardized technique for DPF-MRI performance evaluation has been proposed by a ESUR-ESGAR working group of experts [3].…”

Section: Key Pointmentioning

confidence: 99%

MRI of the Pelvic Floor and MR Defecography

Maccioni

Alt

2018

IDKD Springer Series

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The female pelvic floor is a complex functional and anatomic system. It is composed of an active muscular component and a passive support system. Furthermore, it is topographically divided in three main functional and anatomic compartments: the anterior, supporting the bladder and urethra; the middle, supporting the vagina and uterus; and the posterior or anorectal compartment [1]. When the pelvic floor is damaged in its fascial, muscular, or neural components at the level of any of its three compartments, several pelvic floor dysfunctions or disorders (PFD) may arise [2]. As pelvic floor muscles and fasciae act like a unique functional entity, dysfunction of one compartment is commonly associated with various dysfunctions of the other compartments as well. Hence, a multidisciplinary team, often called a pelvic floor unit, is strongly recommended that includes urogynecologists, urologists, gastroenterologists, proctologists, physicians, radiologists, physiotherapists, and specialized nurses. Additionally, the correct diagnosis of the specific PFD and the identification of all associated disorders are mandatory for an effective conservative or surgical treatment. Dynamic MRI provides excellent morphological and functional display of the pelvic floor and is therefore additionally applied for a comprehensive overview of the pelvic floor and the entire pelvic structures. Evaluation is best done by performing a standardized MRI procedure and using a systemic approach to report the MRI findings [3]. To improve effective communication between the radiologist and the clinician, it is also relevant to understand the specific lesions underlying PFD and to explain the frequent association of disorders in different pelvic compartments. Functional Anatomy of the Pelvic Floor PathogenesisThe pelvic floor is an integrated system composed of an active component, the striated muscles, and a passive support system, the suspensory ligaments and fascial coverings, and is associated with an intricate neural network. It not only provides support for the pelvic viscera (bladder, bowel, uterus) but maintains their functioning, thanks to the combined action of the two major pelvic floor structures: the levator ani muscle (LAM), and the endopelvic fascia [1, 2, 4]. Levator Ani Muscle (LAM)The LAM has two main components: the iliococcygeus and pubococcygeus muscles. Various muscle subdivisions of the LAM are assigned to the medial portions of the pubococcygeus in order to reflect the attachments of the muscle to the Learning Objectives• To gain a basic knowledge on anatomy and pathophysiology of the pelvic floor unit • To get familiar with the recently published general recommendations for standardized imaging and reporting of pelvic floor disorder using MRI • To discuss how to apply these recommendations in case-based evaluations

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Section: Key Pointmentioning

confidence: 99%

MRI of the Pelvic Floor and MR Defecography

Maccioni

Alt

2018

IDKD Springer Series

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“…We used optimum (120ml) amount of ultrasound gel to give better contrast than air as shown by Maccioni Francesca & Al Ansari Najwa et al76 . A higher volume of gel could have provided support to the pelvic structures thus obscuring the prolapsed and thus might have hampered the results.…”

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A Descriptive Study of MR Defecography for Evaluation of Obstructed Defecation Syndrome

Bamboriya

Jaipal

Jakhar

2020

IJMBS

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Objective:-This study aims to ascertain the role of MR Defecography in the evaluation of obstructed defecation syndrome (ODS) with objective to describe spectrum of MR Defecography findings in obstructed defecation syndrome (ODS) and describe a number of reference lines and measurement points used to diagnose and grade pelvic floor disorders and Document the MRI appearance of disorders associated with ano-rectal dysfunction. MR Defecography demonstrated the profile of obstructed defecation syndrome on the basis of MR defecography and demonstrate its utility in simultaneous & objective evaluation of all three pelvic compartments. This diagnostic modalities provide a detailed pelvic floor anatomy and functional evaluation, as well as their respective abnormalities, making a precise diagnosis and provides valuable information on treatment planning & decrease chance of postoperative recurrence. Subjects and Methods: It was Cross-sectional and prospective (quantitative) hospital based descriptive type of observational study carried out at a tertiary hospital SMS hospital, jaipur. Chosen the patients diagnosed with ODS as per Rome criteria (III) whose colonoscopy or rectosigmoidoscopy, had been done to rule out other findings from Feb 2018 to September 2019.MR defecography (static and dynamic) with 3 T (PHILIPS INGENIA) MRI system having tunnel configuration. After written and informed consent, patient was positioned supine in MR machine gantry . Static imaging performed in the axial T1WI high resolution, axial, coronal and sagittal T2WI high resolution images at rest for anatomical evaluation. Following this,after ultrasound gel instilled in the patient’s rectum and intravaginaly ,dynamic imaging were taken in the midsagittal plane through the anal canal using a T2 weighted sequence. This sequence was ran for almost 2 min, while the patient performs various maneuvers (Kegel (squeeze), valsalva menuvere (strain), and defecation). MR defecography structurally and functionally evaluated in all 3 pelvic floor compartments and associated defects noted and grading of specific findings like organ specific prolapse, pelvic floor relaxiation and descent were measured. Results: In our study most common findings were pelvic floor descent and anorectal junction descent in 92.68% cases each followed by rectocele in 82.93% cases. Among the females, vaginal/uterine prolapse were observed in 65.31% cases. Least common findings were paradoxical contraction (8.54%) and sigmoidocele (0%). Significant difference was observed in MRI functional parameters in resting state and during defecation/maximal strain position, utilising HMO system for pelvic floor relaxation and descent, as significant difference (p <0.001S) was observed in all parameters including H line, M line, bladder base descent, cervical/vaginal and anorectal junction descent during resting state and during defecation/maximal strain position. Out of 82 conservative biofeedback therapy was given to 79.27 % patients, surgical management was done in (7.32%) and combination of both therapies was given in 13.41% of cases. Out of 82 patients 68.29% showed benefit from management and showed improvement on follow and 31.71% patients were not improved on follow up. Conclusion: As complete survey of the entire pelvis is necessary before surgical repair Magnetic resonance imaging permits evaluation of all three pelvic compartments and as we demonstrated in our study more than one compartment are frequently affected in obstructed defecation syndrome. Static MR Imaging can be also useful to identify the defects responsible for pelvic organ prolapse and stress urinary incontinence, and so help perform site specific repair in surgery, to avoid the high recurrence rates.Findings reported at dynamic MR imaging of the pelvic floor are valuable for selecting candidates for surgical treatment and for indicating the most appropriate surgical approach as detection rate of pathologies increased during defecation / maximal straning as concluded by our study.

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Erratum to: Prospective Comparison between two different magnetic resonance defecography techniques for evaluating pelvic floor disorders: air-balloon versus gel for rectal filling

Abstract: The given names and family names of all authors were transposed in the original publication. The correct names are as shown above.The online version of the original article can be found at http://dx.doi.

Cited by 2 publications

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MRI of the Pelvic Floor and MR Defecography

MRI of the Pelvic Floor and MR Defecography

A Descriptive Study of MR Defecography for Evaluation of Obstructed Defecation Syndrome

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