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Volume 7, Issue 4 (July & August 2022)                   J Obstet Gynecol Cancer Res 2022, 7(4): 296-303 | Back to browse issues page

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Arian A, Ghanbari Z, Miratashi Yazdi S N, Deldar Pesikhani M, Yousefi M. The High Rate of Discordance Between Clinical Symptoms and MRI Findings in Patients with Pelvic Floor Dysfunction. J Obstet Gynecol Cancer Res. 2022; 7 (4) :296-303
URL: http://jogcr.com/article-1-476-en.html
1- Department of Radiology, Cancer Institute-ADIR, Tehran University of Medical Sciences, Tehran, Iran
2- Department of Gynecology and Obstetrics, Imam Khomeini Hospital, Tehran, Iran
3- Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran , n_miratashi@yahoo.com
4- Advanced Diagnostic and Interventional Radiology Research Center, Tehran, Iran
Abstract:   (655 Views)

Background & Objective: Pelvic floor dysfunctions (PFD) are common disorders among women and affect about 50% of them over 50. About 400,000 American women undergo surgery due to the severity of these disorders. The aim of this study was to investigate the correlation of patients' symptoms with both static and dynamic MRI findings.
Materials & Methods:
In this study, we performed MRI on 60 women suspected of pelvic floor disorders in the Imam Khomeini Hospital complex. Following rectal enema of 60-120 cc sonography gel and vaginal enema of 5-10 cc gel, we performed MRI with 3 Tesla equipment (Siemens Magnetom Trio) utilizing multichannel (16 rows) surface coil on the supine position. Static MRI was performed with high-resolution T2 FSE sequences in sagittal, axial, and coronal planes. Dynamic imaging was done using mid-sagittal T2 HASTE or true FISP in 3 different phases (rest, squeeze, strain and defecogram). The radiologists were blinded to the clinical data of patients.
Our study included 60 patients with a mean age of 52.7±14.3 years. Regarding the MRI findings in patients with urinary symptoms, except for the level I fascial defect, the other findings were not related to the patients' symptoms. Among patients with defecation symptoms, other MRI findings did not have a significant relationship with the patient's symptoms except for severe rectal descent. The association between endopelvic fascial defects and levator muscle injury with sexual complaints was not statistically significant.
Conclusion: In conclusion, these results suggest that the patients' symptoms are not good predictors for MRI findings and are limited in reliability. Thus, MRI must be counted necessary to further evaluate patients with pelvic floor abnormalities. Other studies regarding MRI findings' correlation with different symptoms in these patients are required.

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Systematic Review: Original Research | Subject: General Gynecology and Pelvic Floor
Received: 2021/08/20 | Accepted: 2021/10/16 | Published: 2022/03/14

1. El Sayed RF, Alt CD, Maccioni F, Meissnitzer M, Masselli G, Manganaro L, Vinci V, Weishaupt D. Magnetic resonance imaging of pelvic floor dysfunction-joint recommendations of the ESUR and ESGAR Pelvic Floor Working Group. Eur Radiol. 2017;27(5):2067-85. [DOI:10.1007/s00330-016-4471-7] [PMID] [PMCID]
2. Nygaard I, Bradley C, Brandt D. Pelvic organ prolapse in older women: prevalence and risk factors. Obstet Gynecol. 2004;104(3):489-97. [DOI:10.1097/01.AOG.0000136100.10818.d8] [PMID]
3. Hallock JL, Handa VL. The epidemiology of pelvic floor disorders and childbirth: an update. Obstet Gynecol Clin. 2016;43(1):1-3. [DOI:10.1016/j.ogc.2015.10.008] [PMID] [PMCID]
4. Kelvin FM, Maglinte DD. Dynamic cystoproctography of female pelvic floor defects and their interrelationships. AJR. Am J Roentgenol. 1997;169(3):769-74. [DOI:10.2214/ajr.169.3.9275894] [PMID]
5. Ghanbari Z, Hajibabaei M, Miri Ashtiani E, Ghanbarpour A, Montazeri A. The Impact of Radiofrequency on Pelvic Floor Distress, Restoration, and Sexual Function Among Women Suffering from Pelvic Floor Disorders. J Obstet Gynecol Cancer Res. 2022;7(2):114-20. [DOI:10.30699/jogcr.7.2.114]
6. Schawkat K, Heinrich H, Parker HL, Barth BK, Mathew RP, Weishaupt D, Fox M, Reiner CS. How to define pathologic pelvic floor descent in MR defecography during defecation?. Abdom Radiol. 2018;43(12):3233-40. [DOI:10.1007/s00261-018-1652-7] [PMID]
7. Butrick CW. Pathophysiology of pelvic floor hypertonic disorders. Obstet Gynecol Clin. 2009;36(3):699-705. [DOI:10.1016/j.ogc.2009.08.006] [PMID]
8. 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. [DOI:10.1016/j.ejrnm.2014.03.011]
9. Bump RC, Mattiasson A, Bø K, Brubaker LP, DeLancey JO, Klarskov P, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175(1):10-7. [DOI:10.1016/S0002-9378(96)70243-0]
10. Weber AM, Walters MD, Ballard LA, Booher DL, Piedmonte MR. Posterior vaginal prolapse and bowel function. Am J Obstet Gynecol. 1998;179(6):1446-50. [DOI:10.1016/S0002-9378(98)70008-0]
11. Ellerkmann RM, Cundiff GW, Melick CF, Nihira MA, Leffler K, Bent AE. Correlation of symptoms with location and severity of pelvic organ prolapse. Am J Obstet Gynecol. 2001;185(6):1332-8. [DOI:10.1067/mob.2001.119078] [PMID]
12. 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. [DOI:10.1016/S0022-5347(05)67040-1]
13. Comiter CV, Vasavada SP, Barbaric ZL, Gousse AE, Raz S. Grading pelvic prolapse and pelvic floor relaxation using dynamic magnetic resonance imaging. Urology. 1999;54(3):454-7. [DOI:10.1016/S0090-4295(99)00165-X]
14. Colaiacomo MC, Masselli G, Polettini E, Lanciotti S, Casciani E, Bertini L, et al. Dynamic MR imaging of the pelvic floor: a pictorial review. Radiographics. 2009;29(3):e35. [DOI:10.1148/rg.e35] [PMID]
15. Fitzgerald J, Richter LA. The role of MRI in the diagnosis of pelvic floor disorders. Curr Urol Rep. 2020;21(7):1-6. [DOI:10.1007/s11934-020-00981-4] [PMID]
16. Steiner A, Marks R, Bahrami S, Arif-Tiwari H. How to develop and sustain a successful pelvic floor MRI practice. Abdom Radiol. 2021;46(4):1443-50. [DOI:10.1007/s00261-019-02204-y] [PMID]
17. Pizzoferrato A-C, Timoh KN, Fritel X, Zareski E, Bader G, Fauconnier A. Dynamic Magnetic Resonance Imaging and pelvic floor disorders: how and when? European Journal of Obstetrics & Gynecology and Reproductive Biology. 2014;181:259-66. [DOI:10.1016/j.ejogrb.2014.07.025] [PMID]
18. Ramage L, Georgiou P, Qiu S, McLean P, Khan N, Kontnvounisios C, etal. Can we correlate pelvic floor dysfunction severity on MR defecography with patient-reported symptom severity?. Updates Surg. 2018;70(4):467-76. [DOI:10.1007/s13304-017-0506-0] [PMID] [PMCID]
19. Broekhuis SR, Fütterer JJ, Hendriks J, Barentsz JO, Vierhout ME, Kluivers KB. Symptoms of pelvic floor dysfunction are poorly correlated with findings on clinical examination and dynamic MR imaging of the pelvic floor. Int Urogynecol J. 2009 Oct;20(10):1169-74. [DOI:10.1007/s00192-009-0938-2] [PMID] [PMCID]
20. Reid F. Assessment of pelvic organ prolapse: a practical guide to the pelvic organ prolapse quantification. Obstet Gynaecol Reprod Med. 2014;24(6):170-6. [DOI:10.1016/j.ogrm.2014.04.011]
21. Mariëlle M, Lakeman E, Zijta FM, Peringa J, Nederveen AJ, Stoker J, Roovers R. Dynamic magnetic resonance imaging to quantify pelvic organ prolapse: reliability of assessment and correlation with clinical findings and pelvic floor symptoms. Int Urogynecol J. 2012;23(11):1547. [DOI:10.1007/s00192-012-1772-5] [PMID] [PMCID]
22. Lakeman MM, Zijta FM, Peringa J, Nederveen AJ, Stoker J, Roovers JP. Dynamic magnetic resonance imaging to quantify pelvic organ prolapse: reliability of assessment and correlation with clinical findings and pelvic floor symptoms. Int Urogynecol J. 2012;23(11):1547-54. [DOI:10.1007/s00192-012-1772-5] [PMID] [PMCID]
23. Flusberg M, Sahni VA, Erturk SM, Mortele KJ. Dynamic MR defecography: assessment of the usefulness of the defecation phase. Am J Roentgenol. 2011;196(4):W394-9. [DOI:10.2214/AJR.10.4445] [PMID]
24. El Sayed RF. Overview of the pelvic floor. In:Shaaban AM, editor. Diagnostic imaging: gynecology.2nd edition. Philadelphia: Elsevier-Amirsys;2015. p. 8/2-8/28.
25. Farouk El Sayed R. The urogynecological side of pelvic floor MRI: the clinician's needs and the radiologist's role. Abdom Imag. 2013;38(5):912-29. [DOI:10.1007/s00261-012-9905-3] [PMID]
26. Cundiff GW, Fenner D. Evaluation and treatment of women with rectocele: focus on associated defecatory and sexual dysfunction. Obstet Gynecol. 2004;104(6):1403-21. [DOI:10.1097/01.AOG.0000147598.50638.15] [PMID]
27. Handa VL, Lockhart ME, Fielding JR, Bradley CS, Brubakery L, Cundiffy GW,et al. Racial differences in pelvic anatomy by magnetic resonance imaging. Obstet Gynecol. 2008;111(4):914. [DOI:10.1097/AOG.0b013e318169ce03] [PMID] [PMCID]

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