Dynamic MR colpocystorectography assessing pelvic-floor descent

Eur Radiol. 1997;7(8):1309-17. doi: 10.1007/s003300050294.

Abstract

Magnetic resonance colpocystorectography (MR-CCRG) is presented in the evaluation of patients with pelvic-floor disorders. Five healthy volunteers and 44 female patients with isolated or combined visceral descent underwent dynamic MRI and dynamic fluoroscopy (DF). MR-CCRG was performed with the patient in a supine position using a True FISP sequence (1 image/1.2 s; in-plane resolution 1.02 mm) during pelvic floor contraction, relaxation, and straining maneuvers. Relevant organs, such as urethra, bladder, vagina, and rectum, were opacified by using a saline solution, Magnevist (Schering AG, Berlin, Germany), and sonography gel, respectively. The clinical evaluation and the intraoperative results (30 cases) were used as reference. MR-CCRG and DF were non-diagnostic in 3 cases each. Most patients had a combined type of visceral prolapse, the most frequent combination being a vaginal vault prolapse and a cystocele. The points of reference were sufficiently outlined by DF and MR-CCRG. In comparison with the clinical and intraoperative results, MR-CCRG proved to be especially beneficial in the diagnosis of different types of enteroceles including a uterovaginal prolapse. MR-CCRG showed an equal or higher sensitivity and specificity for all individual sites when compared with DF. Also, predominant herniation obscuring other concomitant prolapse could be verified in 8 cases. MR-CCRG is superior to DF and accurately depicts pelvic-floor descent and prolapse in women. The possibility of dynamic presentation (see enclosed CD-ROM) allows for a better understanding of the organ movements within a given topographic reference setting.

Publication types

  • Comparative Study

MeSH terms

  • Contrast Media
  • Female
  • Fluoroscopy
  • Gadolinium DTPA
  • Hernia / diagnosis*
  • Humans
  • Magnetic Resonance Imaging / methods*
  • Middle Aged
  • Parity
  • Pelvic Floor / pathology
  • Rectal Prolapse / diagnosis*
  • Sensitivity and Specificity
  • Urinary Bladder Diseases / diagnosis*
  • Uterine Prolapse / diagnosis*

Substances

  • Contrast Media
  • Gadolinium DTPA