Dynamic MR colpocystorectography assessing pelvic-floor descent.
Magnetic resonance colpocystorectography (MR-CCRG) is presented in the evaluation of patients with pelvic-floor disorders. Five healthy volunteers and 44 female patients with isolated or combined visceral descent underwent dynamic MRI and dynamic fluoroscopy (DF). MR-CCRG was performed with the patient in a supine position using a True FISP sequence (1 image/1.2 s; in-plane resolution 1.02 mm) during pelvic floor contraction, relaxation, and straining maneuvers. Relevant organs, such as urethra, bladder, vagina, and rectum, were opacified by using a saline solution, Magnevist (Schering AG, Berlin, Germany), and sonography gel, respectively. The clinical evaluation and the intraoperative results (30 cases) were used as reference. MR-CCRG and DF were non-diagnostic in 3 cases each. Most patients had a combined type of visceral prolapse, the most frequent combination being a vaginal vault prolapse and a cystocele. The points of reference were sufficiently outlined by DF and MR-CCRG. In comparison with the clinical and intraoperative results, MR-CCRG proved to be especially beneficial in the diagnosis of different types of enteroceles including a uterovaginal prolapse. MR-CCRG showed an equal or higher sensitivity and specificity for all individual sites when compared with DF. Also, predominant herniation obscuring other concomitant prolapse could be verified in 8 cases. MR-CCRG is superior to DF and accurately depicts pelvic-floor descent and prolapse in women. The possibility of dynamic presentation (see enclosed CD-ROM) allows for a better understanding of the organ movements within a given topographic reference setting.
Lienemann
A
A
Department of Radiology, Klinikum Grosshadern, Ludwig-Maximilians-University, Marchioninistrasse 15, D-81 377 Munich, Germany.
Anthuber
C
C
Baron
A
A
Kohz
P
P
Reiser
M
M
D003287:Contrast Media; D005260:Female; D005471:Fluoroscopy; D019786:Gadolinium DTPA; D006547:Hernia / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D010298:Parity; D017773:Pelvic Floor / Q000473:pathology; D012005:Rectal Prolapse / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D001745:Urinary Bladder Diseases / Q000175:diagnosis*; D014596:Uterine Prolapse / Q000175:diagnosis*
D003287:Contrast Media; D019786:Gadolinium DTPA