The Application Of Three-dimensional Ultrasound In The Assessment Of Levator Ani Muscle Function

0bjectiveTo observe the pelvic floor structure using three-dimensional transperineal ultrasonography, and further analysis the correlation between three-dimensional ultrasound assessment and Oxford muscle strength grading, and also, to test the validity of ultrasound parameters in assessment of levator function in women presenting with different pelvic floor structure changes.Methods1. One hundred and nine patients attending the gynecology clinic of Fuzhou General Hospital were invited to participate in the study: 39 POP women, 38 SUI women and 32 normal controls. Before the ultrasound tests, all the subjects were given verbal instruction of performing PFM contraction and took Oxford grading assessments. The images of the standard midsagittal fi eld and Volume datasets of the pelvic ? oor images at rest and during PFM contraction were acquired. In the sagittal view, the displacement of the bladder neck, the sagittal hiatal diameter, and the levator hiatal angle were measured, the area of the levator hiatus (ALH) was measured in the axial plane of minimum hiatal dimension. The correlation between the ultrasound parameters and Oxford muscle strength were evaluated.2. Ninety-six subjects were selected, including 33 POP women, 34 SUI women and 29 normal controls. We observed and compared the structural changes of the pelvic floor and difference of ultrasound parameters among the three groups.Results1. Of the 106 subjects, 96 subjects were selected (33 POP women, 34 SUI women, 29 normal controls). 2. The analysis of intraobserver reproducibility based on twenty datasets showing highly reproducibility. Intraclass correlation coeff ic ients for intraobserver reliability ranged between 0.769 and 0.975.The correlation coefficient between the ultrasound parameters and Oxford muscle strength were ranged between 0.448 and 0.511. The correlation coefficient of the different ultrasound parameters were ranged between 0.204 and 0.539.3. Transperineal three-dimensional ultrasound can well present the pelvic floor structures.4. Of the tested ultrasound parameters, the ones representing changes of pelvic floor structure from rest to contraction were found non-significant difference among the three groups, while the ones measured at rest and during contraction were found significant difference.Conclusions1. In some extent, three-dimensional ultrasound measurements may reflect the function state of the levator ani, and it correlates strongly with Oxford grading, however, changed pelvic floor structure and the coordination of pelvic floor muscle contraction may have some influences on ultrasound measurement.2. Three-dimensional ultrasound appears to be a reliable tool for study of pelvic floor anatomy, which can be used to observe the defects of pelvic floor.3. The measurement of the LHA and SHD showed that: the levator hiatus of pelvic organ prolapse women was significantly increased, which may be the signs of pelvic floor muscle weakness.4. Methods basing on determining morphological changes in the geometry of pelvic ?oor structures from rest to contraction may be not sensitive enough to distinguish the state of the PFM function presenting with difference pelvic floor structure changes.