Magnetic resonance imaging of defects in DeLancey's vaginal support levels I, II, and III

Huddleston, Harvey T.; Dunnihoo, Dale R.; Huddleston, P.M.; Meyers, Peter C.

doi:10.1016/0002-9378(95)91411-0

Cited by 88 publications

(29 citation statements)

References 7 publications

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“…Anterior vaginal wall support was lost in the incontinent group, with the space of Retzius appearing enlarged and asymmetric. In the MR study of Huddleston et al [15], bilateral fascial defects in MRI were identified in all three levels of support and described as "chevron sign" (level I), "saddlebags sign" (level II), and "mustache sign" (level III). These defects were noted to be corrected postoperatively following paravaginal repair.…”

Section: Discussionmentioning

confidence: 99%

Pelvic architectural distortion is associated with pelvic organ prolapse

2008

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The aim of this study was to determine whether there is an association between architectural distortion seen on magnetic resonance (MR) scans (lateral "spill" of the vagina and posterior extension of the space of Retzius) and pelvic organ prolapse. Secondary analysis of MR imaging scans from a case-control study of women with prolapse (maximum point > or = + 1 cm; N = 144) and normal controls (maximum point < or = -1 cm; N= 126) was done. Two independent investigators, blinded to prolapse status and previously established levator-defect scores, determined the presence of architectural distortion on axial MR scans. Women were categorized into three groups based on levator defects and architectural distortion. Among the three groups, women with levator defects and architectural distortion have the highest proportion of prolapse (78%; p < 0.001). Among women with levator defects, those with prolapse had an odds ratio of 2.2 for the presence of architectural distortion (95% CI = 1.1-4.6). Pelvic organ prolapse is associated with the presence of visible architectural distortion on MR scans.

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Section: Discussionmentioning

confidence: 99%

Pelvic architectural distortion is associated with pelvic organ prolapse

2008

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“…Several studies using MRI have studied the levator ani, including the visualization of defects of the vaginal support (paravaginal defect) [19,20]. The paravaginal defect is considered an important cause of stress urinary incontinence and is defined as detachment of the urethra and vaginal support structures (endopelvic fascia) from the arcus tendineus fascia pelvis during delivery.…”

Section: Discussionmentioning

confidence: 99%

High-resolution endovaginal MR imaging in stress urinary incontinence

et al. 2003

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The causes of stress urinary incontinence are not completely known. Recent papers have stressed the importance of more anatomical information, which may help to elucidate the mechanism of stress urinary incontinence. The purpose of this study was to evaluate the prevalence of lesions of the urethral support mechanism and lesions (defects and scars, thinning) of levator ani muscle with endovaginal MRI in a case-control study. Forty women (median age 52 years, age range 40-65 years)--20 patients with stress urinary incontinence (cases) and 20 age-matched healthy volunteers (controls)--underwent endovaginal MRI: axial, coronal, and sagittal T2-weighted turbo spin echo. The examinations were evaluated for the presence of lesions of urethral supporting structures and levator ani and scar tissue of the levator ani. The thickness of the levator ani muscle was measured. Lesions of the urethral support system and levator ani were significantly more prevalent in cases than in controls ( p<0.01). Median levator ani thickness in patients was significantly lower than in healthy controls [2.5 mm (range 0.9-4.1 mm) vs 3.9 mm (range 1.4-7 mm)] ( p<0.01). This study indicates a relationship between stress urine incontinence and the presence of lesions of the urethral support and levator ani and levator ani thinning.

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“…1b). The mesh was designed based on a Seratom E PA® (Serag Wiessner) mesh, such as what is used for combined reconstruction of a descended uterus (level I defect according to DeLancey et al [14]) with the help of an additional sacrospinous fixation and an anterior vaginal wall defect (level II defect according to DeLancey et al [14]) [15]. The MR-visible threads were woven into all mesh arms and partially into the mesh body using a combination of straight threads and threads woven in a zigzag pattern (fig.…”

Section: Methodsmentioning

confidence: 99%

Magnetic Resonance-Visible Polypropylene Mesh for Pelvic Organ Prolapse Repair

Brocker¹,

Lippus

Alt

et al. 2014

Gynecol Obstet Invest

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Aim: To develop a magnetic resonance (MR)-visible mesh using iron oxides and prove visibility. Methods: In a phantom study, a suitable iron oxide, Fe₃O₄ [iron(II,III) oxide] and FeOOH [iron(III) oxide-hydroxide], concentration was determined using relaxometric MR measurements of the transverse relaxation rates R2 and R2*. Next, a nonabsorbable mesh was designed from the MR-visible threads woven into a polypropylene mesh. The mesh was implanted into a fresh female cadaver via the transobturator route, and MR visibility was assessed with various MR pulse sequences in a clinical 3-tesla system. Results: Optimal contrast was achieved with Fe₃O₄ at 0.2 weight-% in all imaging sequences, and the optimal contrast was achieved in a 3D spoiled gradient-echo (fast low-angle shot) acquisition. In this concentration range the apparent transverse relaxation rate R2* is below 10 ms. The mesh was visible in the cadaver on T1-weighted 3D spoiled gradient-echo images and T1-weighted fast spin-echo images. Conclusion: Mesh materials can be manufactured to be visible on MR with a negative contrast. Fe₃O₄ meshes could simplify follow-up examinations and help diagnose origins of postsurgical lesions after urogynecological procedures with mesh material.

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Magnetic resonance imaging of defects in DeLancey's vaginal support levels I, II, and III

Cited by 88 publications

References 7 publications

Pelvic architectural distortion is associated with pelvic organ prolapse

Pelvic architectural distortion is associated with pelvic organ prolapse

High-resolution endovaginal MR imaging in stress urinary incontinence

Magnetic Resonance-Visible Polypropylene Mesh for Pelvic Organ Prolapse Repair

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