Pelvic static MR vs MR-defecography in the study of woman's pelvic floor disorders

Transcription

1 Pelvic static MR vs MR-defecography in the study of woman's pelvic floor disorders Poster No.: B-0043 Congress: ECR 2015 Type: Scientific Paper Authors: A. ambrosi, G. De Franco, F. Lorusso, M. Cascarano, A. Scardapane, G. Angelelli; Bari/IT Keywords: Pelvis, MR, Defecography, Pelvic floor dysfunction DOI: /ecr2015/B-0043 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 10

2 Purpose To assess static MR and MR-defecography impact in the evaluation of pelvic floor disorders. Page 2 of 10

3 Methods and materials 21 women underwent pelvic-mr and MR-defecography: 8 patients presented constipation, 4 rectal prolapse, 3 bladder prolapse, 3 bladder and uterine prolapse and 2 enterocele. MR examinations were performed in prone position and SSH T2 sequences in the 3 space plans were obtained both in indifferent position and under straining. As later stage the patient's rectum was filled with ultrasound gel and dynamic defecographic images were acquired with B-FFE sequences on a medium sagittal plane (1 sec/image, 110 overall images). In the static scans we considered images obtained at the level of the pubic symphysis to evaluate thickness and symmetry of the levator ani muscles, the levator hiatus, the vaginal morphology and the pubovescical ligaments. MR-Defecogrphy was assessed according HMO system for pelvic floor laxity. The presence of rectocele, rectal intussusception, enterocele and bladder's incontinence was also evaluated. Page 3 of 10

4 Results In the axial static scans we recognized a levator hiatus flare in 5 patients and an asymmetry of the levator ani muscles in 4 patients. Sagittal scans allowed the recognition of 3 rectal prolapses, 2 bladder prolapses and 1 enterocele. In the dynamic defecographic sequences all the cases of bladder and rectal prolapse were identified; 2 rectal intussusceptions, 9 cases of anterior rectocele and 3 cases of bladder's incontinence were also recognised. Page 4 of 10

5 Images for this section: Fig. 1: T2 W images, assial view. The right pubo-rectal muscle is thinned (black arrow) MID - Section of Diagnostic Imaging, University of Bari Medical School - Bari/IT Page 5 of 10

6 Fig. 2: T2 W image, coronal view MID - Section of Diagnostic Imaging, University of Bari Medical School - Bari/IT Page 6 of 10

7 Fig. 3: T2 W image, coronal view during straining. The pubo-rectal muscle shows a reversed shape after straining. MID - Section of Diagnostic Imaging, University of Bari Medical School - Bari/IT Page 7 of 10

8 Fig. 4: Dynamic pelvic MRI. This video shows a pelvic prolapse with rectal intussusception and cystocele. MID - Section of Diagnostic Imaging, University of Bari Medical School - Bari/IT Page 8 of 10

9 Conclusion Static and dynamic MR are complementary techniques and provide essential information to fully understand the complex disorders of women's pelvic floor. Page 9 of 10

10 References 1. Foti PV, Farina R, Riva G et al (2013) Pelvic floor imaging: comparison between magnetic resonance imaging and conventional defecography in studying outlet obstruction syndrome. Radiolol med 118: Silva AC, Maglinte DD (2013) Pelvic floor disorders: what's the best test? Adbom Imaging 38(6): Lalwani N, Moshiri M, Lee JH (2013) Magnetic resonance imaging of pelvic floor disfunction. Radiol Clinic North Am 51(6): Schäfer AO, Bürk J, Baumann T et al (2012) MR defaecography for the diagnosis of obstructive defaecation disorders.zentralb Chir 137(4): Courtney A, Brittany S, Jeffrey M (2010) Imaging pelvic floor disorders: trend toward comprehensive MRI. AJR 194: Schreyer AG, Paetzel C, Fürst A et al (2012) Dynamic magnetic resonance defecography in 10 asyntomatic volunteers. World J Gastroenterol 18(46): Brandão AC, Ianez P (2013) MR imaging of the pelvic floor: defecography. Magn Reson imaging Clin N Am 21(2): Maccioni F (2013) Functional disorders of the ano-rectal compartment of the pelvic floor: clinical and diagnostic value of dynamic MRI. Abdom Imaging 38(5): Page 10 of 10