Pelvic organ movements in asymptomatic nulliparous and symptomatic premenopausal women with pelvic organ prolapse in dynamic MRI: a feasibility study comparing midsagittal single-slice with multi-slice sequences

Abstract

Purpose To compare multi-slice (MS) MRI sequences of the pelvis acquired at rest and straining to dynamic midsagittal single-slice (SS) sequences for the assessment of pelvic organ prolapse (POP). Methods This IRB-approved prospective single-center feasibility study included 23 premenopausal symptomatic patients with POP and 22 asymptomatic nulliparous volunteers. MRI of the pelvis at rest and straining was performed with midsagittal SS and MS sequences. Straining effort, visibility of organs and POP grade were scored on both. Organ points (bladder, cervix, anorectum) were measured. Differences between SS and MS sequences were compared with Wilcoxon test. Results Straining effort was good in 84.4% on SS and in 64.4% on MS sequences (p = 0.003). Organ points were always visible on MS sequences, whereas the cervix was not fully visible in 31.1–33.3% on SS sequences. At rest, there were no statistically significant differences of organ point measurements between SS and MS sequences in symptomatic patients. At straining, positions of bladder, cervix, and anorectum were + 1.1 cm (± 1.8 cm), − 0.7 cm (± 2.9 cm), and + 0.7 cm (± 1.3 cm) on SS and + 0.4 mm (± 1.7 cm), − 1.4 cm (± 2.6 cm), and + 0.4 cm (± 1.3 cm) on MS sequences (p < 0.05). Only 2 cases of higher-grade POP were missed on MS sequences (both with poor straining effort). Conclusion MS sequences increase the visibility of organ points compared to SS sequences. Dynamic MS sequences can depict POP if images are acquired with sufficient straining effort. Further work is needed to optimize the depiction of the maximum straining effort with MS sequences. Graphical abstract

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

“…Exclusion criteria were inability to follow the instructions during the MR image acquisition, failure to return the questionnaire or undergo physical examination (for patients only), history of prior pelvic floor surgery, insufficient straining maneuver during the dynamic phase of the MRI, and general contraindications to MRI (e.g., presence of non-MR-compatible metallic implants, devices or metallic foreign bodies). A part of this cohort was previously used for another study with a different research objective that focused on comparison of different techniques for acquisition of dynamic MRI sequences [ 16 ].…”

Quantitative 3D Analysis of Levator Ani Muscle Subdivisions in Nulliparous Women: MRI Feasibility Study

“…This measurement system is independent of other pelvic structures as well as individual horizontal or slant planes. Recently, the 3D characterization of pelvic ligaments [18] and pelvic organ movements in asymptomatic and symptomatic premenopausal women in dynamic MRI could be demonstrated in feasibility studies of the 3D-PICS coordinate system [19].…”