The role of a new three‐dimensional ultrasound technique in the diagnosis of levator ani muscle avulsion

Abstract

Aims: To evaluate the intermethod agreement between the tomographic ultrasound imaging (TUI), considered as the gold standard, and the OmniView-VCI in the diagnosis of levator ani muscle (LAM) avulsion and in the measurement of levator-urethral gap (LUG). Methods:We acquired dynamic 4D transperineal ultrasound volumes from 114 women. Each data set was analyzed on maximal pelvic floor contraction by TUI and OmniView-VCI techniques to check for LAM avulsion. Moreover, we measured LUG using both TUI and OmniView-VCI, twice by an operator and once by another to assess intraobserver and interobserver reproducibility.Reproducibility and intermethod agreement were studied by means of intraclass correlation coefficient (ICC) and Cohen's kappa coefficient. Results: In the diagnosis of ani levator avulsion, the two techniques showed a good agreement (Cohen's κ = 0.691, 95% confidence interval [CI], 0.522-0.860; P < .001); we also reported a good intraobserver and interobserver agreement (Cohen's κ = 0.738, 95% CI, 0.597-0.879; P < .001, and Cohen's κ = 0.864, 95% CI, 0.750-0.978; P < .001, respectively). LUG measurements by OmniView-VCI technique showed high intraobserver (ICC 0.895; 95% CI, 0.866-0.918) and interobserver (ICC 0.821; 95% CI, 0.774-0.858) reproducibility. High intermethod agreement was demonstrated between the two methods (ICC 0.813; 95% CI, 0.764-0.853). The area under the receiver-operating characteristic curve of LUG in predicting avulsion was 0.931 (0.868-0.994, 95% CI; P < .001) with 24 mm showing the best sensitivity (82%) and specificity (97%). Conclusions:OmniView-VCI is a reliable method for LUG measurement and for levator avulsion diagnosis. K E Y W O R D S 3D ultrasound, avulsion, levator muscle, pelvic floor, transperineal ultrasound

The correlation between transperineal ultrasound assessment of the levator ani muscle and postpartum urinary incontinence

“…It is advocated that the widespread use of imaging has the potential to change the management of pelvic floor morbidity 6–8 . 3D/4D TPU has made it possible to reliably diagnose levator ani muscle (LAM) damage 9,10 . Many studies have found correlations between LAM injuries and pelvic floor dysfunction 11 .…”

The dynamic change of the anteroposterior diameter of the levator hiatus under Valsalva maneuver at term and labor outcome

“…TPU provides an accurate and reproducible tool for the assessment of the pelvic floor dimensions and lesions of the LAM. 5,6,18 Many studies have evaluated the effects of vaginal birth on the pelvic floor. Indeed, LAM avulsion and levator hiatal overdistension are associated with a considerably increased risk of pelvic floor dysfunction, such as pelvic organ prolapse (POP), signs and symptoms of POP and vaginal laxity.…”

The optimal cutoff value for levator‐urethra gap measurements using tomographic ultrasound imaging in avulsion diagnosis is population specific

“…Therefore, it seems that our cutoff of 2.305 cm is the optimal value for our patient population. Montaguti et al 17 compared the OmniView-VCI technique to TUI for diagnosis of Levator avulsion, and found good agreement between the methods with an optimal cutoff value of 2.4 cm on OmniView-VCI method, with a sensitivity of 82% and a specificity of 97%. Had we used the previously published LUG cutoffs on our patient population overall, we would miss a significant number of women who would have gone undiagnosed and possibly prevented from receiving necessary care.…”

“…The levator‐urethra gap (LUG) is the distance between the urethral lumen center and the levator insertion site on the inferior pubic rami. Previous studies evaluating LUG measurements have shown different cutoff values for the LUG 1,10,12‐17 . A cutoff of 2.5 cm has been reported in Australian women, 13 while in Chinese women, the cutoff was 2.365 cm 10 .…”

“…Previous studies evaluating LUG measurements have shown different cutoff values for the LUG. 1,10,[12][13][14][15][16][17] A cutoff of 2.5 cm has been reported in Australian women, 13 while in Chinese women, the cutoff was 2.365 cm. 10 It seems that ethnic variation occurs which may question the validity of this cutoff for widespread use.…”