3 T MRI-based measurements for the integrity of the female pelvic floor in 25 healthy nulliparous women.
OBJECTIVE
Measurements indicating a loss of integrity of the levator ani muscle, which is an integral part of the pelvic floor, have been subject of recent studies using translabial ultrasound and 3D-MRI-models. We transferred these measurements into 2D-3 T-MR-images for clinical routine, as it is objective and does not need exhaustive post-processing.


METHODS
The trial was accepted by the local ethics committee. 25 healthy volunteers fulfilled the inclusion criteria and gave written informed consent. Using high-resolution T2-weighted images (TE 5030-7810 ms, TR 88-112 ms, matrix 512, FOV 280-300 mm, ST 2-3 mm), measurements of anteroposterior hiatus (APH), laterolateral hiatus (LLH), hiatal area (HA), hiatal circumference (HC), levator area (LA), maximum muscle thickness (MMT) and levator urethra gap (LUG) were transferred from ultrasound, iliococcygeus width (IW), puborectalis attachment width (PAW), and levator symphysis gap (LSG) were transferred from 3D-MRI-models. We compared our results to previous studies in the literature.


RESULTS
Mean value was 52.22 ± 6.97 mm for APH, 33.15 ± 4 mm for LLH, 13.22 ± 3.05 cm(2) for HA, 14.19 ± 1.61 cm for HC, 7.14 ± 1.85 cm(2) for LA, 6.45 ± 2.07 mm for MMT, 19.47 ± 2.38 mm for LUG, 45 ± 3.97 mm for IW, 33.94 ± 3.34 mm for PAW, 20.54 ± 5.29 mm for LSG. Our results for APH, HA, LUG, and with limitations LA, were comparable to the literature, while HC, LLH, and MMT showed anatomical variances. Results for IW and LSG were comparable, but challenging to measure. We newly proposed a cutoff value for PAW.


CONCLUSIONS
2D-3 T-MRI combines high-resolution images with objective measurements of parameters regarding pelvic floor integrity, without resorting to exhaustive post-processing methods. Our results may provide a good foundation for further 2D-MR-studies.
Department of Diagnostic and Interventional Radiology, University of Heidelberg Medical School, Heidelberg, Germany.
Céline D
CD
Alt
Department of Obstetrics and Gynecology, University of Heidelberg Medical School, Heidelberg, Germany.
Franziska
F
Hampel
Radiological Department Darmstadt, Academic Teaching Practice of the University of Heidelberg Medical School, Darmstadt, Germany.
Peter
P
Hallscheidt
Department of Obstetrics and Gynecology, University of Heidelberg Medical School, Heidelberg, Germany.
Christof
C
Sohn
Department of Obstetrics and Gynecology, University of Heidelberg Medical School, Heidelberg, Germany.
Bettina
B
Schlehe
Department of Obstetrics and Gynecology, University of Heidelberg Medical School, Heidelberg, Germany.
Kerstin A
KA
Brocker
D000328:Adult; D059925:Anatomic Landmarks; D003430:Cross-Sectional Studies; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging; D010298:Parity; D017773:Pelvic Floor / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D055815:Young Adult
female pelvic floor; healthy volunteers; magnetic resonance imaging; muscle avulsion; pubovisceral muscle