title: [Study on morphological characteristics of uterosacral and cardinal ligament in patients with severe pelvic organ prolapse based on MRI].
abstract: OBJECTIVE
  To evaluate morphological structure of uterosacral ligament (USL) and cardinal ligament (CL) in patients with severe pelvic organ prolapse (POP) by MRI technology, and to analysis and discuss its clinical significance.
  
  
  METHODS
  From November 2013 to February 2014 in Peking University People's Hospital, 26 elderly patients with III-IV degree of POP were selected as the POP group and 18 healthy elderly volunteers were selected as the control group during the same period. Pelvic MRI examination were performed in the two groups. The morphological characteristics of left and right side of the uterosacral-cardinal ligament on MRI and the attachment site of the starting and ending points between two group were described and compared.
  
  
  RESULTS
  In POP group, 25 cases of left USL starting point were located in the sacrospinous ligament/coccygeal muscle complex [58% (15/26)] or coccygeal muscle [38% (10/26)], ending point were located in the cervix and vagina [58% (15/26)] or cervix [38% (10/26)]; 24 cases of right USL starting point were located in the sacrospinous ligament/coccygeal muscle complex [31% (8/26)] or coccygeal muscle [62% (16/26)], 26 cases of right USL ending point were located in the cervix and vagina [62% (16/26)] or cervix [38% (10/26)]; the left and right CL in the POP group and the control group were both from the sacroiliac joint at the top of the greater sciatic foramen from the ipsilateral pelvic side wall; 1 case (4%, 1/26) of left CL in the POP group completely connected to the bladder, 10 cases (38%, 10/26) partly connected to the bladder; 14 cases (54%, 14/26) of right CL partly connected to the bladder, the rest ending points of left and right CL were located in cervix and (or) vagina. In the control group, 17 cases of left USL starting point were located in the sacrospinous ligament/coccygeal muscle complex (10/18) or coccygeal muscle (7/18), ending point were located in the cervix and vagina (12/18) or cervix (6/18); 18 cases of right USL starting point were located in the sacrospinous ligament/coccygeal muscle complex (10/18) or coccygeal muscle (8/18), ending point were located in the cervix and vagina (13/18) or cervix (5/18); 8 cases (8/18) of left CL partly connected to the bladder; 15 cases (15/18) of right CL partly connected to the bladder, the rest ending points of left and right CL were located in cervix and (or) vagina. There was no significant difference between the two groups on the starting and ending points (P > 0.05).
  
  
  CONCLUSIONS
  The observation of MRI could be consistent with the clinical anatomy on the starting and ending points, direction of travel in the uterosacral-cardinal ligament. The starting and ending points of the left and right side USL and the ending points of the left and right side CL are not completely symmetrical, the variation degree is large, some CL could be completely or partly inserted to the bladder.
authors.affiliation: Department of Obsterics and Gynecology, Peking University People's Hospital, Beijing 100044, China.
authors.forename: Xinxin
authors.initials: X
authors.lastname: Ma
authors.forename: Shiyao
authors.initials: S
authors.lastname: Shang
authors.forename: Bing
authors.initials: B
authors.lastname: Xie
authors.forename: Xiuli
authors.initials: X
authors.lastname: Sun
authors.forename: Xin
authors.initials: X
authors.lastname: Yang
authors.forename: Jing
authors.initials: J
authors.lastname: Wu
authors.forename: Nan
authors.initials: N
authors.lastname: Hong
authors.affiliation: Email: wjianliu@netease.com.
authors.forename: Jianliu
authors.initials: J
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D002584:Cervix Uteri / Q000033:anatomy & histology* / Q000473:pathology; D002681:China; D005260:Female; D006801:Humans; D007512:Ischium / Q000033:anatomy & histology; D008022:Ligaments / Q000033:anatomy & histology* / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D017773:Pelvic Floor; D056887:Pelvic Organ Prolapse / Q000473:pathology*; D010537:Peritoneum; D012447:Sacrum / Q000033:anatomy & histology; D001743:Urinary Bladder; D014599:Uterus / Q000033:anatomy & histology; D014621:Vagina / Q000033:anatomy & histology* / Q000473:pathology