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Background: Functional disorders of the pelvic ?oor are a common clinical problem. Diagnosis and treatment of these disorders, which frequently manifest with nonspeci?c symptoms such as constipation or incontinence, remain dif?cult. MR Defecography has emerged over the last decade as a modality which additionally images the pelvic floor function in real time besides combining the advantages of previously used modalities and that of magnetic resonance i.e. multiplanar imaging, good temporal resolution and lack of radiation exposure. Dynamic MRI defecography is a relatively new imaging protocol which can be extremely useful in identification of anatomic and functional pelvic floor dysfunction such as organ prolapse, anismus and fecal incontinence. Excellent demonstration of the perirectal soft tissues allows assessment of spastic pelvic ?oor syndrome and descending perineum syndrome and visualization of enteroceles. The aim of the study was to assess causes of pelvic floor dysfunction.Methods: Authors evaluated 25 patients with cine Magnetic Resonance Defecography at our center between December 2018 and 15th May 2019. MR Defecography was done with help of 3 Tesla Somatom Seimens MRI. Ultrasound jelly was instilled into the rectum of patient via a short flexible tube while the patient lies in the lateral decubitus position on the scanner table before being moved into the gantry and was asked to defecate when instructed. Scanning was done in four phases-resting, straining, squeezing and defecation as per the standard protocol while patient lied supine.Results: Most common complaint encountered was that of constipation. Patients in age group 20-70 years were studied. Maximum patient were of the age group 40-50 years. Most common finding was organ prolapse in total 9 patients with anterior rectocele in 6 patients followed by rectal prolapse.Conclusions: Magnetic resonance defecography is an excellent modality for assessment of pelvic floor disorders. It has very good temporal resolution and high soft tissue contrast, also allows visualization of the pelvic floor function in real-time without any radiation load. Imaging the defecation process in real-time leads to a definitive diagnosis in cases of dysfunctional defecation and a precise diagnostic and pre-operative assessment in cases of organ prolapse.
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Objective To investigate the consistency and stability of two types of pubococcygeal line (PCL) determined by dynamic MRI used in evaluating pelvic organ prolapse (anterior and apical compartments).The first type of PCL was measured from the inferior pubic symphysis to the tip of coccyx (PCLtip) and the second was to the sacrococcygeal joint (PCLjnt).Methods Dynamic MRI changes of 50 female patients who were diagnosed with pelvic organ prolapse by pelvic organ prolapse quantification were retrospective reviewed.Chi-square test was used to compare the staging of each pelvic compartment (anterior,apical) with the two PCLs.The lengths and the degree of the oblique angle of the two PCLs during the rest and straining were compared using a paried t test.Results Agreement of PCLjnt with PCLtip was 96％ (48/50) for anterior compartment and 94％ (47/50) for apical compartment.There was no difference between the two PCLs in staging of each pelvic compartment (anterior,apical)(x2 values were 2.000 and 3.000,P values were 0.368 and 0.223).The length of the PCLtip at rest and straining was (10.1±0.8),(10.2± 0.8) cm respectively and the result was statistical significance (t=-2.339,P=0.023).Twenty patients (40％) in the 50 pelvic organ prolapse patients demonstrated a shortening of the PCLtip,while the rest including 30 patients (60％) was longer.The oblique angle of the PCLtip at rest and straining was 22°±6° and 18°±11° respectively(t=3.490,P=0.001).The length of the PCLjnt at rest and straining were (11.2±0.8) and (11.2± 0.8)cm respectively(t=-1.845,P=0.071).The oblique angle of the PCLjnt at rest and straining were 29°±6° and 26°± 10° (t=2.836,P=0.007),but the degree of PCLjnt's oblique angle had a mild fluctuate compared with the PCLtip.Conclusions PCLjnt and PCLtip have the equal level in staging of anterior and apical pelvic organ prolapse.Meanwhile the oblique angle and the length of PCLjnt illustrated the better the stability.
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Objective To assess the correlation between magnetic resonance imaging (MRI)and clinical staging of pelvic organ prolapse (POP)by using pubococcygeal line (PCL)and midpubic line (MPL)respectively.And to determine which(MRI)reference line for staging pelvic organ prolapse had the highest agreement with clinical staging.Methods A retrospective study of 32 women with pelvic organ prolapse who underwent dynamic pelvic MRI from Jan 2013 to May 2013 was conducted.One radiologist staged descent on MRI for each pelvic compartment (anterior,middle,posterior),using PCL and MPL lines.Agreement between MRI and clinical staging was estimated respectively.Results Thirty-two women were included.Agreement between clinical and MPL staging was morderate in the anterior (κ=0.44,SE=0.13)and middle compartment (κ=0.46,SE=0.12),but fair in the posterior com-partment (κ=0.23,SE=0.10).Agreement between clinical and PCL staging was poor in all compartments of pelvic.Conclusion MPL appeared more reliable and simple than the PCL for the evaluation of pelvic prolapse on MRI.
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The method of defecography and its newly designed measuring ruler are described. There were 26 cases (27.08%) with abnormal findings in 96 subjects without defecatory disturbance. In 70 cases of normal value,the mean value of the anorectal angle(ARA) was 98.67?13.84 (62-123) at rest and 114.84?14.92 (94-151) during defecation. The distance between the anorectal junction (the upper part of anal canal) and the pubococcygeal line(DUAC) was 9.87?7.72 mm (-10-30 mm) at rest and 20.36?8.37 mm (-5-50 mm) during defecation. We suggest that the DUAC in Chinese should be ≤30 mm during defecation and the relative normal value of the parous women should be ≤35 mm. The length of the anal canal during defecation was 37.03?6 mm(25-50 mm), 39.67?5.47mm (30-50mm) in males and 34.33?4.19mm (27-50mm) in females. The distance between the sigmoid and the pubococcygeal line (DSPC) should be negative during defectation.