Study of dynamic magnetic resonance imaging in diagnosis of pelvic organ prolapse.
BACKGROUND
Pelvic floor dysfunction and prolapse affect 50 % of women past middle age. Failure to recognize the complex set of pelvic floor defects in individuals leads to most post-surgical failures. Imaging has so far not had an established role in the investigation of prolapse. The present study is an attempt to define the role of magnetic resonance imaging in POP.


METHODS
Thirty patients with clinically graded stage III/IV prolapse underwent routine physical examination and grading of POP in the Department of Obstetrics and Gynaecology, AIIMS. Dynamic MR evaluation with TRUFISP configuration was done and organ prolapse was measured through the hiatal line (HMO classification). The agreement of MRI, physical examination and intra-operative examination was analyzed using kappa as the test of agreement.


RESULTS
Twenty-eight subjects with grade III and 2 subjects with grade IV prolapse were enrolled. The mean age was 52.8 and the mean parity was 3.63. On MRI, 19 patients were found to have grade III prolapse, 4 had grade IV prolapse and the rest had grade I and II prolapse. There was poor agreement of MRI with clinical examination in anterior and middle compartments (k 0.161, k 0.144). The agreement between MRI and Intra-operative findings was 0.369, 0.422 for anterior and posterior compartments. Kappa was 0.085 for rectocele and 0.710 for enteroceles. The agreement was better for posterior compartment and enterocele. MRI detected 5 out of 8 enteroceles intra-operatively.


CONCLUSIONS
The study demonstrates that while dynamic MRI does not confer any additional advantage in the diagnosis of anterior and middle compartment defects, the diagnosis of enteroceles, which may be missed clinically, is efficiently made on dynamic MRI imaging. Additionally, MRI can differentiate enterocele from a high rectocele which can further classify the surgery needed. There is also a need to standardize the protocol and the role of MR imaging in POP.
Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, AIIMS, Ansari Nagar East, 3076, 3rd Floor, Teaching Block, New Delhi 110029, India. shrutigupta1984@gmail.com
Shruti
S
Gupta
J B
JB
Sharma
Smriti
S
Hari
Sunesh
S
Kumar
K K
KK
Roy
Neeta
N
Singh
D000328:Adult; D000368:Aged; D005260:Female; D006547:Hernia / Q000175:diagnosis; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000175:diagnosis*