Preoperative and Postoperative Magnetic Resonance Imaging of Female Pelvic Floor Dysfunction: Correlation with Clinical Findings

Sayed, El; Mashed, Sahar El; Morsy, Mohamed M.; Azim, Mohamed S. Abd El

doi:10.1097/01.jwi.0000201538.37340.95

Cited by 10 publications

(9 citation statements)

References 21 publications

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“…Of course, the next step is to determine how patients with these defects will be treated best, but this research has yet to be performed. Indeed, MRI evaluations of women with pelvic floor dysfunction provided significant information that altered clinical management in 41.6% of patients with urinary incontinence in one study [38], and MRI and cystocolpoproctography findings led to changes in the initial operative plan in 41% of patients with pelvic floor dysfunction in another study [39].…”

Section: Discussionmentioning

confidence: 99%

Anatomy of the Urethral Supporting Ligaments Defined by Dissection, Histology, and MRI of Female Cadavers and MRI of Healthy Nulliparous Women

Sayed

Morsy

Mashed

et al. 2007

American Journal of Roentgenology

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CMEThis article is available for CME credit. See www.arrs.org for more information.OBJECTIVE. There has been no uniformity of opinion concerning the structures supporting the female urethra. Therefore, the aims of this prospective study were to define precisely the female urethral support structures at cadaveric anatomic dissection and histologic examination and to determine which of these structures can be detected on MRI of cadaveric specimens and of healthy volunteers.SUBJECTS AND METHODS. Dissection of seven formalin-preserved cadavers (age at death, 25-50 years; no parity history available) was performed by a professor of anatomy to explore the anatomy of the urethral supporting ligaments and was followed by MRI of the cadaveric specimens with ligamentous markers in place and then by histologic analysis of the dissected ligaments. MRI of 17 healthy nulliparous women (age range, 20-35 years; mean age, 25.5 years) was then performed using T2-weighted, dual turbo spin-echo, balanced fast-field echo, and STIR sequences. A standardized grid system that allowed us to record structural observations on sequentially numbered axial MR images was used by a radiologist who then applied a 4-point grading scale to assess ligament visibility. Three authors-one radiologist, one anatomist, and one urologist-then compared the appearance of each ligament seen in a cadaveric specimen with its appearance on MR images of the same cadaver and on MR images of volunteers.RESULTS. At cadaveric dissection we identified ventral and dorsal urethral ligaments. The ventral urethral ligaments included the pubourethral ligaments, which were found to consist of three separate components coursing anteroposterior from the bladder neck to the pubic bone; the periurethral ligament; and the paraurethral ligaments. Dorsal to the urethra, a slinglike ligament, which we believe should be named the "suburethral ligament," was identified. This ligament had a distinct plane of cleavage from the anterior vaginal wall. The MRI findings in the volunteers correlated with the MRI and gross anatomic findings in the cadavers. The proximal pubourethral, periurethral, paraurethral, and suburethral ligaments had visibility scores of 3 (moderately visible) or 4 (easily visible) on MRI in 47%, 65%, 47%, and 53% of volunteers, respectively.CONCLUSION. Our results present evidence that may help resolve previous controversies regarding the MR appearance of the ventral urethral ligaments and that better define the course of the ligament dorsal to the urethra, the suburethral ligament. We hope that this detailed anatomic information about the structures involved in continence may lead eventually to improvements in the treatments for women with stress urinary incontinence. F Downloaded from www.ajronline.org by 117.253.101.235 on 10/09/15 from IP address 117.253.101.235.

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Section: Discussionmentioning

confidence: 99%

Anatomy of the Urethral Supporting Ligaments Defined by Dissection, Histology, and MRI of Female Cadavers and MRI of Healthy Nulliparous Women

Sayed

Morsy

Mashed

et al. 2007

American Journal of Roentgenology

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“…We recognize that the utility of demonstrating the specific abnormality in the pelvic supporting structures in the management and treatment of pelvic floor dysfunction still must be validated, just as the reproducibility of our proposed analytic approach has to be de-termined. Nevertheless, it is worth mentioning that promising results have been reported with respect to the ability of imaging to change patient care in 41.6% (37), 41% (38), and 75% (39) of patients with different spectra of pelvic floor dysfunction.…”

Section: Tablementioning

confidence: 99%

Pelvic Floor Dysfunction: Assessment with Combined Analysis of Static and Dynamic MR Imaging Findings

Sayed¹,

Mashed²,

Farag³

et al. 2008

Radiology

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“…Static MR images visualize pelvic floor anatomy and defects of the supporting structures, while dynamic MR images visualize pelvic organ mobility, pelvic floor weakness, pelvic organ prolapse (POP) and associated compartment defects [ 5 , 8 – 11 ]. Additionally, MRI may diagnose unexpected underlying masked functional abnormalities, which might be discrepant from the dominant symptom and may influence the choice of the surgical technique in around 42 % of patients with different spectra of PFD [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…Several studies and detailed reviews are published about MRI of the pelvic floor and different acronyms have been used for this examination including static and dynamic MR of the pelvic floor, MR defecography or MR proctography [ 4 , 12 , 14 – 16 ]. However, to date, there is neither consensus on a standardized imaging protocol nor on a systematic reporting scheme for MR-imaging of PFD.…”

Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging of pelvic floor dysfunction - joint recommendations of the ESUR and ESGAR Pelvic Floor Working Group

et al. 2016

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ObjectiveTo develop recommendations that can be used as guidance for standardized approach regarding indications, patient preparation, sequences acquisition, interpretation and reporting of magnetic resonance imaging (MRI) for diagnosis and grading of pelvic floor dysfunction (PFD).MethodsThe technique included critical literature between 1993 and 2013 and expert consensus about MRI protocols by the pelvic floor-imaging working group of the European Society of Urogenital Radiology (ESUR) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) from one Egyptian and seven European institutions. Data collection and analysis were achieved in 5 consecutive steps. Eighty-two items were scored to be eligible for further analysis and scaling. Agreement of at least 80 % was defined as consensus finding.ResultsConsensus was reached for 88 % of 82 items. Recommended reporting template should include two main sections for measurements and grading. The pubococcygeal line (PCL) is recommended as the reference line to measure pelvic organ prolapse. The recommended grading scheme is the “Rule of three” for Pelvic Organ Prolapse (POP), while a rectocele and ARJ descent each has its specific grading system.ConclusionThis literature review and expert consensus recommendations can be used as guidance for MR imaging and reporting of PFD.Key points • These recommendations highlight the most important prerequisites to obtain a diagnostic PFD-MRI. • Static, dynamic and evacuation sequences should be generally performed for PFD evaluation. • The recommendations were constructed through consensus among 13 radiologists from 8 institutions.

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Preoperative and Postoperative Magnetic Resonance Imaging of Female Pelvic Floor Dysfunction: Correlation with Clinical Findings

Cited by 10 publications

References 21 publications

Anatomy of the Urethral Supporting Ligaments Defined by Dissection, Histology, and MRI of Female Cadavers and MRI of Healthy Nulliparous Women

Anatomy of the Urethral Supporting Ligaments Defined by Dissection, Histology, and MRI of Female Cadavers and MRI of Healthy Nulliparous Women

Pelvic Floor Dysfunction: Assessment with Combined Analysis of Static and Dynamic MR Imaging Findings

Magnetic resonance imaging of pelvic floor dysfunction - joint recommendations of the ESUR and ESGAR Pelvic Floor Working Group

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