Dynamic magnetic resonance imaging used in evaluation of female pelvic prolapse: experience from nine cases.

Prolapse of pelvic organs in a female can be simple or complex. To make a definite diagnosis of pelvic prolapse preoperatively, dynamic magnetic resonance (MR) is an alternative to conventional fluoroscopic or sonographic examination, with the advantage of providing greater details, and thus helping the surgeon to have a good preoperative plan. Nine women suffering from pelvic prolapse with or without urinary stress incontinence underwent dynamic MR imaging examination (1.0T Magnex100/HP, Shimadzu, Kyoto, Japan) before surgery. All patients were examined in the supine position. A single-shot ultra-high speed scan (FE/8/3.02-20 degrees, 128, 100%-100% 1 NEX 1 slice 10 mm L1.0 second) was used to obtain midline sagittal images, with the patients at rest and during pelvic strain. MR images were then obtained every 4 seconds. Each examination was analyzed, based on specific measurements, to determine the presence and extent of prolapse of pelvic organs. The pubococcygeal, levator hiatus width and muscular pelvic floor relaxation lines, and the angle of the levator plate were identified. Based on these measurements, multicompartment involvement in the pelvic prolapse was confirmed in five patients (5/9). Four patients (4/9) had single compartment involvement. Seven patients underwent surgery. All patients reported significant improvement in their symptoms and signs after surgical intervention. Two patients had an almost complete recovery. MR demonstrated simple or complex organ descent in all pelvic compartments, and may become a standard preoperative examination for pelvic floor abnormalities. The MR images facilitated comprehensive planning by the surgeon; thus, they can increase the success rate and help to accurately predict the outcome of the surgical intervention. The surgeons also expressed high postsurgical satisfaction with the information provided by dynamic MR.

Post-traumatic ligamentum flavum hematoma: a case report.

We present the case of a 64-year-old female treated surgically for ligamentum flavum hematoma that caused progressive radiculopathy. Initially, she suffered from an acute onset of lower back pain. Only a history of minor back injury was discovered. She rapidly became unable to walk. Magnetic resonance imaging demonstrated an epidural mass lesion at L3 to L4 that was continuous with the left ligamentum flavum. The mass was hypointense on T1-weighted images and centrally hyperintense and marginally hypointense on T2-weighted images. The margin was well enhanced by gadopentetate dimeglumine administration. After removal of the mass, the patient's symptoms completely resolved. Before surgery, we believe accurate diagnosis of ligamentum flavum hematoma can be based on magnetic resonance imaging.