Dynamic magnetic resonance imaging in evaluation of female pelvic organ prolapse

الملخص EN

Objective : The aim of this study is to evaluate the role of dynamic MRI in diagnosis of pelvic organ prolapsed (POP).

Patients and Methods : Forty-three female patients were included in this prospective observational study with age range from 25 to 70 year.

They presented with POP and voiding dysfunction.

They were evaluated by dynamic pelvic MRI at our institute.

The MRI examination was done using superconducting magnet 1.5 teals with surface body coil.

The patient was positioned supine in the magnet.

Then dynamic fast images were obtained using single shot T2 - weighted sequence in the sagittal plane in sequential images during voluntary strain.

The images were analyzed by drawing the following lines : Pubo-coccygeal line (PCL) : as a reference line, H line and M line.

Extent of POP by MRI was measured by the vertical distance from the PCL to the most inferior portion of the bladder base, cervix or vaginal vault and ano-rectal junction.

Results : A total of 43 female patients were included with mean age 42.8 ± 9.8 years and mean parity of 5 (range 0-10).

History of previous pelvic floor repair was reported in 8 patients and vaginal hysterectomy in 2 patients.

Stress urinary incontinence was the most presenting symptom (69.8%) followed by constipation (60.5 %) and heaviness in the pelvis (53.5%).

MRI depicted cystocele in 40 patients with a mean urinary bladder base descent below PCL by 2.80 ± 1.9 cm.

Uterine-cervical descent was detected by MRI in 31 patients with mean descent below PCL 1.99 ± 1.8cm as well as vaginal vault prolapsed in 2 patients with descent of vaginal vault below PCL by 1cm.

MRI depicted Excessive ano-rectal descent in 40 patients with mean 4.04 ± 1.2cm, anterior rectocele in 43 patients and enterocele in 21 patients.

All patients have pelvic floor relaxation with mean H line (7.31 ± 1.03 cm) and mean M line (4.42±1.47 cm).

Multi-compartment organ prolapsed was found in all patients.

Conclusion : MRI is a new non-invasive imaging modality for evaluation of POP with encouraging results especially in those with multi-compartment prolapsed.