DYNAMIC MAGNETIC RESONANCE IMAGING: AN AID TO PREOPERATIVE-PLANNING OF PELVIC ORGAN PROLAPSE
AbstractBackground: Magnetic resonance imaging (MRI) has been commonly used in the assessment of pre-operative pelvic organ prolapse to evaluate anatomical defects prior to surgery. This study aimed at evaluating the dynamic MRI reliability in the determination of pelvic organ prolapse and to assess its compliance with the physical examination for preoperative planning of women. Methods: A prospective cross-sectional study was performed at the radiology department of the Jinnah Postgraduate Medical Centre Karachi from April-October 2019. All women irrespective of age and parity status having obstructed defecation, constipation, organ prolapse, pelvic pain, or stress urinary incontinence undergoing dynamic pelvic MRI were consecutively enrolled. A brief history was obtained followed by a physical examination for pelvic organ prolapse followed by MRI examination. Kappa coefficient was applied to see the agreement of physical examination with MRI finding. Results: A total 38 women were included. A significantly moderate agreement was observed between MRI and physical exam findings with respect to the presence or absence of cystocele (K=0.554, p<0.001), rectocele (K=0.632, p<0.001), and enterocele (K=0.587, p<0.001). However, agreement with respect to the MRI and physical examination findings on uterine descent was non-significant (K= 0.130, p 0.421). Conclusion: MRI examination is an effective diagnostic modality in determination of the pelvic organ prolapse in suspected symptomatic patients. MRI could add value primarily in research areas, taking into account its ability to examine the entire pelvis. Conclusion MRI examination is an effective diagnostic modality in determination of the pelvic organ prolapse in suspected symptomatic patients. Keywords Pelvic organ prolapse, dynamic magnetic resonance imaging, physical examination
Weber AM, Richter HE. Pelvic organ prolapse. Obstet Gynecol 2005;106(3):615–34.
Durnea CM, Khashan AS, Kenny LC, Durnea UA, Smyth MM, O’Reilly BA. Prevalence, etiology and risk factors of pelvic organ prolapse in premenopausal primiparous women. Int Urogynecol J 2014;25(11):1463–70.
Gyhagen M, Bullarbo M, Nielsen TF, Milsom I. Prevalence and risk factors for pelvic organ prolapse 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG: Int J Obstert Gynaecol 2013;120(2)152–60.
Van Geelen JM, Dwyer PL. Where to for pelvic organ prolapse treatment after the FDA pronouncements? Int Urogynecol J 2013;24(5):707–18.
Donon L, Warembourg S, Lapray JF, Cortesse A, Hermieu JF, Fatton B, et al. Assessment before surgical treatment for pelvic organ prolapse: Clinical practice guidelines. Prog Urol 2016;26(Suppl 1):S8–26.
Boyadzhyan L, Raman SS, Raz S. Role of static and dynamic MR imaging in surgical pelvic floor dysfunction. Radiographics 2008;28(4):949–67.
Azab IA, Nasef MA, Ibrahim AM. Dynamic magnetic resonance imaging; reliability of assessment and correlation with clinical findings of pelvic organ prolapse. Egypt J Radiol Nucl Med 2014;45(3):1003–10.
Lienemann A, Sprenger D, Janßen U, Grosch E, Pellengahr C, Anthuber C. Assessment of pelvic organ descent by use of functional cine‐MRI: Which reference line should be used? Neurourol Urodyn 2004;23(1):33–7.
Gousse AE, Barbaric ZL, Safir MH, Madjar S, Marumoto AK, Raz S. Dynamic half Fourier acquisition, single shot turbo spin-echo magnetic resonance imaging for evaluating the female pelvis. J Urol 2000;164(5):1606–13.
Lin FC, Funk JT, Tiwari HA, Kalb BT, Twiss CO. Dynamic Pelvic Magnetic Resonance Imaging Evaluation of Pelvic Organ Prolapse Compared to Physical Examination Findings. Urology 2018;119:49–54.
Cimsit C, Yoldemir T, Akpinar IN. Prevalence of dynamic magnetic resonance imaging-identified pelvic organ prolapse in pre-and postmenopausal women without clinically evident pelvic organ descent. Acta Radiol 2016;57(11):1418–24.
Xie B, Chen L, Xue Z, English EM, Fenner DE, Gaetke-Udager K, Kolenic GE, et al. Comparison of measurement systems for posterior vaginal wall prolapse on magnetic resonance imaging. Int Urogynecol J 2019;30(8):1269–77.
Gupta S, Sharma JB, Hari S, Kumar S, Roy KK, Singh N. Study of dynamic magnetic resonance imaging in diagnosis of pelvic organ prolapse. Arch Gynecol Obstet 2012;286(4):953–8.
Fauconnier A, Zareski E, Abichedid J, Bader G, Falissard B, Fritel X. Dynamic magnetic resonance imaging for grading pelvic organ prolapse according to the International Continence Society classification: which line should be used? Neurourol Urodyn 2008;27(3):191–7.
Cortes E, Reid WM, Singh K, Berger L. Clinical examination and dynamic magnetic resonance imaging in vaginal vault prolapse. Obstet Gynecol 2004;103(1):41–6.
Lienemann A, Sprenger D, Janssen U, Grosch E, Pellengahr C, Anthuber C. Assessment of pelvic organ descent by use of functional, cine-MRI: which reference line should be used? Neurourol Urodyn 2004;23(1):33–7.
Goodrich MA, Webb MJ, King BF, Bampton AE, Campeau NG, Riederer SJ. Magnetic resonance imaging of pelvic floor relaxation: dynamic analysis and evaluation of patients before and after surgical repair. Obstet Gynecol 1993;82(6):883–91.