title: Levator avulsion using a tomographic ultrasound and magnetic resonance-based model.
abstract: OBJECTIVE
  Delivery-related levator avulsion can cause pelvic floor dysfunction. We compared agreement between tomographic ultrasound and magnetic resonance-based models for the detection of levator defects.
  
  
  METHODS
  Sixty-nine Chinese women with pelvic organ prolapse were assessed prospectively by 3-dimensional ultrasound scans and magnetic resonance imaging. Levator-urethra gap (LUG), levator-symphysis gap (LSG), and puborectalis attachment width were measured offline with state-of-the-art software. Interobserver variability and agreement between the 2 methods were determined.
  
  
  RESULTS
  Interobserver repeatability was moderate-to-excellent for all parameters that were measured with both methods and agreement between methods in diagnosing levator avulsion. LUG and LSG measurements were significantly higher in women with a levator avulsion. With a diagnosis of complete levator avulsion, receiver operating characteristics analysis suggested a cutoff of 23.65 mm for LUG and 28.7 mm for LSG.
  
  
  CONCLUSIONS
  Levator avulsion can be diagnosed reliably by tomographic ultrasound scanning and magnetic resonance imaging evaluation, and linear measures, such as LSG and LUG, can be proxy measurements for avulsion.
authors.affiliation: Department of Obstetrics and Gynecology, Fujian Medical University, Fuzhou, Fujian, China. cin-derella2008@163.com
authors.forename: Rong R
authors.initials: RR
authors.lastname: Zhuang
authors.forename: Yan F
authors.initials: YF
authors.lastname: Song
authors.forename: Zi Q
authors.initials: ZQ
authors.lastname: Chen
authors.forename: Ming
authors.initials: M
authors.lastname: Ma
authors.forename: Hui J
authors.initials: HJ
authors.lastname: Huang
authors.forename: Jin H
authors.initials: JH
authors.lastname: Chen
authors.forename: Yun M
authors.initials: YM
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001004:Anus Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D017773:Pelvic Floor / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D014463:Ultrasonography