640 Slice CT Dynamic Evaluation Of Female Pelvic Floor Functional Disorder

Purpose:To explore the feasibility and application value of using 640 slice CT to detect female Stress Urinary Incontinence (SUI) and Pelvic Organ Prolapse (POP) dynamically, then to sum the varying pattern of female Pelvic floor during pre-voiding, voiding and post-void.Method:From September 2012-April 2015, we selected 62 patients with stress urinary incontinence and 36 patients with pelvic organ prolapsed as study goup. For the control group, we selected 50 female volunteers subjects, who didn’t suffer from PFD and din’t have any operation in pelvic. Both group were adult female. All subjects were inspected with 640 slice dynamic volume of bladder and urethra cystocolpoproctography and pelvic CT for three-dimensional imaging, recording the imaging, analyzingthe subjects pelvic structures (such as bladder, urethra, and the supporitng syster of pelvic floor), which could provide us the continuous changes during urination. The POP and SUI patients were diagnosed according to the International Continence Society(ICS) (on the basis of medical history, physical examination, POP-Q questionnaire and urodynamics). We rebuild 3D(three-dimention) and 4D(four-dimention) image according the axis image. Since 0.175s half circle scan can get single phase 3D graphics, with 0.5s interval sampling stage multiple phase can be get more 3D image data. It can scan the whole urination. The 4D dynamic images was got from the continuous playback of these 3D images, The changing of bladder and urethra in during voiding can be observed in a multiphase dynamic 3d images, which make us to analyze the urination process.Urination process can be divided into pre-voiding, voiding and post-void. We measure the urethral inclined angle, Poster Urethro Vesical Angle(PUVA) and Pubo Coccygeal line (PCL), H line, M line, distance of bladder neck and the cervical to PCL and make comparison of the these data at every phase. PCL is a line of the lower edge of pubic to sacrococcjoints, M line is the length of anorectal connection to PCL, Reflex the length of levatorani muscle vertical drop, H line is the length of the edge of pubic to anorectal connection, reflex the anteroposterior diameter of levator hiatal.Result:1. In Control group, SUI group and POP group,the general condition such as age, family status, BMI and so on had no statistically differences (P> 0.05).2. The length of H line in Each group is changing during resting and straining, post-void The changing trend is increased with the straining, which has the statistically significance according to the variance test comparison. According to the LSD-t test, the differene of H line in each group,had statistically significancance.at resting and on straining, post-voiding.3. In the study, we use variance test to comparing each period’s M line in same group and found that they also had statistically significant. In each group, M line at straining had a trend of increase at rest and post-voidign, of the control group the M line is more longer than in resting and urinating, and in late urination of the SUI and POP group the M line is shortened. In each group the corresponding period’s M line use the LSD-t test to compare, the control group and the SUI and POP group’s M line had difference in each period, the SUI and POP group’s M line had no obvious difference at rest and later urination, and had significant difference on straining.4. We measure the distance of bladder neck to PCL (PCL-BN) with positive value and negative value. The positive value represented bladder neck which is located above the PCL. The negative value indicates bladder neck below in the PCL. In each group, PCL-BN on straining had a trend of descend compare with the rest. At rest, the control group’s bladder neck were located above the PCL, a few subjects bladder neck is located below the PCL in urinating. In SUI and POP group there are few patients bladder neck is located below the PCL at rest, and intensify on straining. In each group, the corresponding period’s PCL-BN compare each other and showed that the control group compare with the SUI and POP group’s PCL-BN have obvious difference when at rest and during urinating and the degree of bladder neck movement also has the obvious difference.The SUI group compare with the POP group’s PCL-BN have no obvious difference in each periods.5. About the the distance of cervix to PCL (PCL-C), we use positive value and negative value to represent cervix above or below the PCL. The positive value represent the cervix which is located above the PCL whereas the negative value indicates the cervix below the PCL.Within each group, the PCL-C that compared in the resting with in urinating have statistical significance differences.Within each group, the PCL-C that compared in urinating with in resting descend. In control group the position of the cervix is above the PCL at rest and straining.the SUI and POP group’s cervix are located in the above of PCL at rest, and in straining the position of the cervix descend, the POP group decreased obviously(most were below the PCL about 10 mm). In each group of the corresponding period PCL-BN to compare and show:the control group, the SUI and POP group in resting and in straining PCL-C all have obvious difference, but no obvious difference was found between control group and SUI group’s degree of cervix mobility. While the control group compared with the SUI group and POP group, the cervix mobility degrees have obvious difference.6. In this study,control group, SUI group and POP group’s urethral inclined angel during resting and straining had significant difference statistically.With micturition action, urethral inclined angel was increased.The urethral inclined angel of control group and SUI group during resting had no difference, but there was obvious difference in straining, the urethral inclined angel of control group and POP group have obvious differences in resting and in straining. The urethral inclined angel of SUI and POP group have no obvious difference in resting and in straining.7.In this study, the control group, SUI and POP group, the poster urethra vesical angle(PUVA) between each groups during the resting and straining had statistically significant difference.With micturition action, the poster urethrovesical angle showed a trend of increase.Control group and SUI group during resting and straining there were significant differences. Control group and POP group has no obvious difference during resting, and in urinating the poster urethrovesical angle exists obvious difference. SUI group and POP group in the resting and in urinating when there were no obvious difference.Conclusion:1.640 layer CT can clearly showed the bony structure,pelvic organs and pelvic floor muscles, but it was not so clear for boundary of the pelvic floor muscles as MRI.2. In the resting, on straining and late urination, each group’s H line,M line, urethral inclined angel, poster urethrovesical angle, distance of the bladder neck to PCL and the cervical to PCL had statistically difference.3. In the resting period, urination period and late urination period, the H line, M line, urethral inclined angel, poster urethrovesical angle, distance of the bladder neck to PCL and the cervical to PCL had statistically difference between each group.4. The PCL, H line, M line, the distance of the bladder neck and the cervical to PCL, urethral inclined angel, poster urethrovesical angle had statistical differences, which has clinical effectiveness in diagnosing the SUI and POP.5. It is feasible and has certain clinical application value to diagnose SUI and POP with 640 layer CT image and 3D/4D imaging..