Imaging Study Of Normal Pelvic Floors And Pelvic Floors With Complex Pelvic Floor Functional Diseases

Objectives To search for the best imaging model for diagnosing complex pelvic floor functional diseases, the author studied position and movement of pelvic organs and the shape of pelvic floors of normal asymptomatic female volunteers and those of patients with complex pelvic floor functional diseases. Dynamic Magnetic Resonance Imaging (MRI) has been performed both at rest and during pelvic strain. The results were compared with those of the simultaneous combined pelvic organograph. The study is to evaluate the value and limitations of dynamic MRI and simultaneous combined pelvic organograph in diagnosing complex pelvic floor functional diseases and to explore the relationship between complex pelvic floor functional diseases and the morphological patterns of the pelvic floors produced by dynamic MRI.Methods Thirty women with complex pelvic floor disorders(the disease group) were examined with pelvic floor dynamic MRI and simultaneous combined pelvic organograph, which includes cystourethrography, peritoneography, colpography and defecography. Thirty female asymptomatic volunteers(the normal group) were also examined by pelvic floor dynamic MRI with the same parameters as what were used in the study group. All dynamic MR imaging at rest and during pelvic strain were used to observe position and movement of pelvic organs and the shape of pelvic floors, and pelvic organ prolapses and pelvic floor pathological changes. Simultaneous combined pelvic organograph was used to diagnose pelvic organ prolapses and pelvicfloor pathological changes in disease group. Pearson's phi coefficients were calculated between the results of dynamic MRI and those of combined pelvic organograph examinations. The differences between the dynamic MRI measurement results of the normal group and those of the disease group were examined statistically.Results The bladder neck should not descend more than 1 cm below the pubococcygeal line, the vaginal cuff and cervix did not descend more than the pubococcygeal line, the anorectal junction descended no more than 2.5 cm below the pubococcygeal line and the shape of pelvic floors did not distinct change with maximal pelvic strain in the normal group. Pelvic visceral prolapse was seen at multiple locations, most frequently with patients with the functional disease of the pelvic floor. Compared with the asymptomatic group, the disease group has significantly more cystocele (P < 0.01), uterocervical prolapse (P < 0.01), pelvic floor hernia (P < 0.01), anorectal junction excessive descent (P < 0.01), rectocele (P < 0.01) ,and pelvic diaphragm hiatus expanding (P < 0.001). There is high concurrence of diagnoses with dynamic MRI and for pelvic organs prolapses. Diagnoses by dynamic MRI matches that of the combined pelvic organograph perfectly on cystocele (100%), and less so on other prolapses: anorectal junction excessive descent (95.2%), pelvic floor hernia (86.7%) and uterocervical prolapse (85.7%). The value of pelvic floor dyamic MRI in diagnosing anorectal functional disease is rather limited. It is insensitive to detect rectocele, cannot display rectal mucosa prolapse and intussusception at all, and has little value in assessing the velocity and integrality of defecation.Conclusion In pelvic floors dynamic MR imaging, the normal woman have seldem pelvic organ prolapses and distinct change of the shape of pelvic floors during pelvic strain. Complex pelvic floor functional diseases generaldisplay multiple pelvic organ prolapses and pelvic floor pathological changes, which includes cystocele, uterocervical prolapse, pelvic floor hernia, anorectal junction excessive descent, rectocele, and sometimes significant expansion of pelvic diaphragm hiatus. Pelvic floor dynamic MRI and simultaneous combined pelvic organograph have similar diagnostic value with regard to complex pelvic floor functional disease. Both of them can be used to evaluate multiple pelvic organ prolapses and pelvic floor pathological changes accurately. There are high diagnostic concurrence between dyamic MRI and comb...