title: Translabial three-dimensional ultrasonography compared with magnetic resonance imaging in detecting levator ani defects.
abstract: OBJECTIVE
  To assess the diagnostic performance of translabial three-dimensional ultrasonography in detecting major levator ani defects in women with pelvic organ prolapse compared with magnetic resonance imaging (MRI) and to assess the interobserver agreement in detecting levator ani defects with translabial three-dimensional ultrasonography.
  
  
  METHODS
  In a multicenter cohort study, 140 women indicated for primary surgery of pelvic organ prolapse quantification stage II or more cystocele were included. Patients undergoing mesh surgery or concomitant stress incontinence surgery were excluded. All consenting patients underwent translabial three-dimensional ultrasonography and MRI of the pelvic floor before surgery. Two observers (out of a pool of four observers) assessed translabial three-dimensional ultrasound images; two other observers (out a pool of five observers) assessed MRIs for levator ani muscle damage. In case of disagreement, the images were discussed in a consensus meeting.
  
  
  RESULTS
  Of the 135 scans, 45 major levator ani defects were detected on ultrasonogram (33.3%) and 32 were confirmed at MRI (23.7%). Of the 41 major levator ani defects detected on MRI, nine were missed at translabial three-dimensional ultrasonogram. Sensitivity was 0.78 (32 of 41) (95% confidence interval [CI] 0.65-0.91) and specificity was 0.86 (81 of 94) (95% CI 0.79-0.93) in detecting major levator ani defects with translabial three-dimensional ultrasonography compared with MRI. There was good agreement scoring levator ani defects on translabial three-dimensional ultrasonography, with a κ of 0.67 (95% CI 0.58-0.76); agreement in recognizing major levator ani defects was moderate, with a κ of 0.53 (95% CI 0.37-0.69).
  
  
  CONCLUSIONS
  Translabial three-dimensional ultrasonography shows reasonable agreement with MRI in detecting major levator defects. Because of the moderate interobserver agreement, it will be difficult to implement ultrasonography in daily practice.
  
  
  BACKGROUND
  Netherlands Trial Register, www.trialregister.nl, NTR2220.
authors.affiliation: Departments of Obstetrics and Gynaecology and Radiology, Maastricht University Medical Center, Maastricht, and University Medical Center Nijmegen, Nijmegen, the Departments of Radiology, Obstetrics and Gynaecology, and Epidemiology, Amsterdam Medical Center, Amsterdam, the Department of Radiology, Atrium Medical Center, Heerlen, and 10GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Kim J B
authors.initials: KJB
authors.lastname: Notten
authors.forename: Kirsten B
authors.initials: KB
authors.lastname: Kluivers
authors.forename: Jurgen J
authors.initials: JJ
authors.lastname: Fütterer
authors.forename: Karlijn J
authors.initials: KJ
authors.lastname: Schweitzer
authors.forename: Jaap
authors.initials: J
authors.lastname: Stoker
authors.forename: Femke E
authors.initials: FE
authors.lastname: Mulder
authors.forename: Regina G
authors.initials: RG
authors.lastname: Beets-Tan
authors.forename: Roy F A
authors.initials: RFA
authors.lastname: Vliegen
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Bossuyt
authors.forename: Roy F P M
authors.initials: RFPM
authors.lastname: Kruitwagen
authors.forename: Jan-Paul W R
authors.initials: JWR
authors.lastname: Roovers
authors.forename: Mirjam
authors.initials: M
authors.lastname: Weemhoff
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008875:Middle Aged; D017773:Pelvic Floor / Q000000981:diagnostic imaging*; D056887:Pelvic Organ Prolapse / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D014463:Ultrasonography