Magnetic resonance imaging to evaluate anterior pelvic prolapse: H line is the key

Abstract

Introduction:The aim of the study is to compare clinical staging of anterior pelvic prolapse with magnetic resonance imaging (MRI) staging, using the pubococcygeal line (PCL), the midpubic line (MPL), and the H line as reference lines. Moreover, we aim to analyze interrater reliability of each reference line.Material and Methods: Forty-two women with pelvic organ prolapse (POP) symptoms were studied using the pelvic organ prolapse quantification on physical examination. Two different observers calculated anterior POP using the three MRI reference lines, retrospectively. Agreement between MRI and clinical staging was estimated using Pearson correlation for the quantitative measurements and kappa index for the stages. Interrater reliability was estimated using the intraclass correlation coefficient (ICC).Results: Correlation between physical examination and the H line was high by both observers (r = 0.86 and r = 0.76, p < 0.01). The correlation was lower using MPL (r = 0.76 and r = 0.65, p < 0.01). The results of comparing MRI staging and physical examination were: κ = 0.618 and κ = 0.602 for the H line, κ = 0.273 and κ = 0.267 for MPL and κ = −0.105 and κ = −0.140 for PCL. The results of interrater reliability were: ICC of 0.968 for the H line, ICC of 0.788 for MPL, and ICC of 0.737 for PCL. Conclusion:Anterior POP staging using MRI H line as a reference presents a better agreement with clinical staging than PCL or MPL. The H line has better interrater reliability. The H line could replace the current lines.

Importance of Translabial Ultrasound for the Diagnosis of Pelvic Organ Prolapse and Its Correlation with the POP-Q Examination: Analysis of 363 Cases

“…The defecation proctography has been regarded as a gold standard in conjunction with a physical examination in assisting diagnostic and surgical approaches to rectocele [ 23 ]. MRI has also been introduced for pelvic floor disorders with high-resolution images of the muscles, ligaments, and sphincters, as well as functional information obtained through dynamic MRI [ 24 , 25 ]. However, defecation proctography and MRI are rarely used in the daily clinic because these modalities are relatively expensive, are not very acceptable by the patients, and have risks of radiation exposure or allergic reactions to the contrast media used during the imaging studies.…”

Assessment of pelvic organ prolapse with the Pelvic Inclination Correction System: defining the normal range and threshold to pathology

“…Rechi-Sierra et al [ 9 ] compared three reference lines, namely PCL, MPL, and the H-line to physical examination and found low agreement between clinical prolapse stage and MRI grade using the MPL and PCL. The H-line is drawn from the inferior ramus of the pubic symphysis to the reflection of the puborectalis muscle in the posterior rectum.…”

Translabial ultrasound for pelvic organ prolapse

“…Consequently, imaging techniques have been used to detect pelvic floor deflects and their association with neighboring organs, as an accompaniment to the POP-Q method. Even with the critical information provided by defecation proctography and MRI [ 2 , 43 ], they are seldom used in daily clinical practice, because they are costly, may not be accepted by patients, and carry risks of radiation exposure or allergic reactions to the contrast media. TLUS is more widely utilized because it is a commonly used, user-friendly imaging modality that is cheaper, easier to perform, and quicker, taking approximately 5 minutes.…”