title: Feasibility of diffusion tensor imaging (DTI) with fibre tractography of the normal female pelvic floor.
abstract: OBJECTIVE
  To prospectively determine the feasibility of diffusion tensor imaging (DTI) with fibre tractography as a tool for the three-dimensional (3D) visualisation of normal pelvic floor anatomy.
  
  
  METHODS
  Five young female nulliparous subjects (mean age 28 ± 3 years) underwent DTI at 3.0T. Two-dimensional diffusion-weighted axial spin-echo echo-planar (SP-EPI) pulse sequence of the pelvic floor was performed, with additional T2-TSE multiplanar sequences for anatomical reference. Fibre tractography for visualisation of predefined pelvic floor and pelvic wall muscles was performed offline by two observers, applying a consensus method. Three eigenvalues (λ1, λ2, λ3), fractional anisotropy (FA) and mean diffusivity (MD) were calculated from the fibre trajectories.
  
  
  RESULTS
  In all subjects fibre tractography resulted in a satisfactory anatomical representation of the pubovisceral muscle, perineal body, anal - and urethral sphincter complex and internal obturator muscle. Mean FA values ranged from 0.23 ± 0.02 to 0.30 ± 0.04, MD values from 1.30 ± 0.08 to 1.73 ± 0.12 × 10(-)³ mm²/s. Muscular structures in the superficial layer of the pelvic floor could not be satisfactorily identified.
  
  
  CONCLUSIONS
  This study demonstrates the feasibility of visualising the complex three-dimensional pelvic floor architecture using 3T-DTI with fibre tractography. DTI of the deep female pelvic floor may provide new insights into pelvic floor disorders.
authors.affiliation: Department of Radiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. f.m.zijta@amc.uva.nl
authors.forename: F M
authors.initials: FM
authors.lastname: Zijta
authors.forename: M
authors.initials: M
authors.lastname: Froeling
authors.forename: M P
authors.initials: MP
authors.lastname: van der Paardt
authors.forename: M M E
authors.initials: MM
authors.lastname: Lakeman
authors.forename: S
authors.initials: S
authors.lastname: Bipat
authors.forename: A D Montauban
authors.initials: AD
authors.lastname: van Swijndregt
authors.forename: G J
authors.initials: GJ
authors.lastname: Strijkers
authors.forename: A J
authors.initials: AJ
authors.lastname: Nederveen
authors.forename: J
authors.initials: J
authors.lastname: Stoker
mesh_terms: D000328:Adult; D000465:Algorithms; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D018485:Muscle Fibers, Skeletal / Q000166:cytology*; D017773:Pelvic Floor / Q000033:anatomy & histology*; D012016:Reference Values; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity