Magnetic resonance imaging of pelvic floor relaxation: dynamic analysis and evaluation of patients before and after surgical repair.
OBJECTIVE
To evaluate structures involved in pelvic support using conventional and snapshot magnetic resonance imaging (MRI).


METHODS
We used conventional spin-echo MRI and dynamic snapshot GRASS MRI at various levels of the Valsalva maneuver to describe and quantitate the anatomy of pelvic floor relaxation and to assess anatomical changes produced by surgical repair. Ten female volunteers were evaluated to define normal anatomy and reference measurements. Five women with pelvic floor relaxation were evaluated before and after surgical repair.


RESULTS
Static and dynamic MRI were more sensitive than clinical pelvic examination in assessing and grading pelvic floor relaxation. Quantitative results showed widening of the levator hiatus and more vertical lie of the levator plate postoperatively. Descent of the pelvic organs on maximal straining postoperatively was the same as that in normal volunteers. The posterior urethrovesical angle on MRI was more than 110 degrees in 14 of 15 continent subjects.


CONCLUSIONS
Magnetic resonance imaging may be valuable in analyzing and assessing pelvic floor relaxation and in understanding anatomical changes occurring before and after surgical repair. The increased sensitivity of MRI in grading prolapse may make it useful in evaluating women with symptoms of pelvic floor relaxation but who have negative findings on clinical examination.
Goodrich
M A
MA
Section of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota.
Webb
M J
MJ
King
B F
BF
Bampton
A E
AE
Campeau
N G
NG
Riederer
S J
SJ
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009126:Muscle Relaxation; D017773:Pelvic Floor / Q000473:pathology* / Q000601:surgery*; D011184:Postoperative Period; D011300:Preoperative Care; D011391:Prolapse