Abstract
Over the last decade advances in commercial MR technology have facilitated the development and integration of dynamic MR imaging into the workup of patients with pelvic floor disorders. Dynamic MR imaging demonstrates movement of the pelvic floor and organs, providing functional information refl ecting ligamentous or muscular injury, atrophy or dysfunction. Additionally, it has several advantages over conventional fluoroscopic cystoproctography. The intrinsic T2-weighted signal differences of the pelvic organs provide excellent visualization of the bladder, vagina, small bowel and rectum with minimal preparation, as well as direct visualization of the pelvic floor musculature. The use of cross-sectional imaging eliminates problems of superimposition, magnification and measurement at traditional fluoroscopy. The multiplanar capabilities of MR permit dynamic coronal and axial imaging unavailable using fluoroscopic methods.
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References
Barnett JL, Hasler WL, Camilleri M (1999) American Gastroenterological Association medical position statement on anorectal testing techniques. American Gastroenterological Association. Gastroenterology 116:732–760
Bartram CI, Turnbull GK, Lennard-Jones JE (1988) Evacuation proctography: an investigation of rectal expulsion in 20 subjects without defecatory disturbance. Gastrointest Radiol 13:72–80
Bharucha AE (2006) Pro: Anorectal testing is useful in fecal incontinence. Am J Gastroenterol 101:2679–2681
Bharucha AE, Fletcher JG (2007) Recent advances in assessing anorectal structure and functions. Gastroenterology 133:1069–1074
Bharucha AE, Fletcher JG, Harper CM et al (2005) Relationship between symptoms and disordered continence mechanisms in women with idiopathic faecal incontinence. Gut 54:546–555
Bharucha AE, Fletcher JG, Seide B et al (2005) Phenotypic variation in functional disorders of defecation. Gastroenterology 128:1199–1210
Busse RF, Riederer SJ, Fletcher JG et al (2000) Interactive fast spin-echo imaging. Magn Reson Med 44:339–348
Cheung O, Wald A (2004) Review article: the management of pelvic floor disorders. Aliment Pharmacol Ther 19:481–495
Christensen LL, Djurhuus JC, Constantinou CE (1995) Imaging of pelvic floor contractions using MRI. Neurourol Urodyn 14:209–216
Comiter CV, Vasavada SP, Barbaric ZL et al (1999) Grading pelvic prolapse and pelvic floor relaxation using dynamic magnetic resonance imaging. Urology 54:454–457
Deutekom M, Dobben AC, Terra MP et al (2007) Clinical presentation of fecal incontinence and anorectal function: what is the relationship? Am J Gastroenterol 102:351–361
Fielding JR, Griffiths DJ, Versi E et al (1998) MR imaging of pelvic floor continence mechanisms in the supine and sitting positions. AJR Am J Roentgenol 171:1607–1610
Fletcher JG, Busse RF, Riederer SJ et al (2003) Magnetic resonance imaging of anatomic and dynamic defects of the pelvic floor in defecatory disorders. Am J Gastroenterol 98:399–411
Fox JC, Fletcher JG, Zinsmeister AR et al (2006) Effect of aging on anorectal and pelvic floor functions in females. Dis Colon Rectum 49:1726–1735
Goh V, Halligan S, Kaplan G et al (2000) Dynamic MR imaging of the pelvic floor in asymptomatic subjects. AJR Am J Roentgenol 174:661–666
Greenberg T, Kelvin FM, Maglinte DD (2001) Barium trapping in rectoceles: are we trapped by the wrong definition? Abdom Imaging 26:587–590
Gufler H, Laubenberger J, DeGregorio G et al (1999) Pelvic floor descent: dynamic MR imaging using a half-Fourier RARE sequence. J Magn Reson Imaging 9:378–383
Halligan S, Bartram CI, Park HJ et al (1995) Proctographic features of anismus. Radiology 197:679–682
Healy JC, Halligan S, Reznek RH et al (1997) Patterns of prolapse in women with symptoms of pelvic floor weakness: assessment with MR imaging. Radiology 203:77–81
Healy JC, Halligan S, Reznek RH et al (1997) Magnetic resonance imaging of the pelvic floor in patients with obstructed defaecation. Br J Surg 84:1555–1558
Hetzer FH, Andreisek G, Tsagari C et al (2006) MR defecography in patients with fecal incontinence: imaging findings and their effect on surgical management. Radiology 240:449–457
Hjartardottir S, Nilsson J, Petersen C et al (1997) The female pelvic floor: a dome — not a basin. Acta Obstet Gynecol Scand 76:567–571
Hussain SM, Stoker J, Lameris JS (1995) Anal sphincter complex: endoanal MR imaging of normal anatomy. Radiology 197:671–677
Kaufman HS, Buller JL, Thompson JR et al (2001) Dynamic pelvic magnetic resonance imaging and cystocolpoproctography alter surgical management of pelvic floor disorders. Dis Colon Rectum 44:1575–1583; discussion 1583–1584
Kelvin FM, Maglinte DD, Hale DS et al (2000) Female pelvic organ prolapse: a comparison of triphasic dynamic MR imaging and triphasic fluoroscopic cystocolpoproctography. AJR Am J Roentgenol 174:81–88
Lienemann A, Anthuber C, Baron A et al (1997) Dynamic MR colpocystorectography assessing pelvic-floor descent. Eur Radiol 7:1309–1317
Macura KJ GR, Bluemke DA (2006) MR imaging of the female urethra and supporting ligaments in assessment of urinary incontinence: spectrum of abnormalities. Radiographics 26:1135–1149
Maglinte DD, Kelvin FM, Fitzgerald K et al (1999) Association of compartment defects in pelvic floor dysfunction. AJR Am J Roentgenol 172:439–444
Ozasa H, Mori T, Togashi K (1992) Study of uterine prolapse by magnetic resonance imaging: topographical changes involving the levator ani muscle and the vagina. Gynecol Obstet Invest 34:43–48
Pannu HK, Kaufman HS, Cundiff GW et al (2000) Dynamic MR imaging of pelvic organ prolapse: spectrum of abnormalities. Radiographics 20:1567–1582
Rao SS (2006) A balancing view: Fecal incontinence: test or treat empirically-which strategy is best? Am J Gastroenterol 101:2683–2684
Shorvon PJ, McHugh S, Diamant NE et al (1989) Defecography in normal volunteers: results and implications. Gut 30:1737–1749
Stoker J, Rociu E (1999) Endoluminal MR imaging of diseases of the anus and rectum. Semin Ultrasound CT MR 20:47–55
Stoker J, Halligan S, Bartram CI (2001) Pelvic floor imaging. Radiology 218:621–641
Strohbehn K, Ellis JH, Strohbehn JA et al (1996) Magnetic resonance imaging of the levator ani with anatomic correlation. Obstet Gynecol 87:277–285
Strohbehn K, Quint LE, Prince MR et al (1996) Magnetic resonance imaging anatomy of the female urethra: a direct histologic comparison. Obstet Gynecol 88:750–756
Tan IL, Stoker J, Zwamborn AW et al (1998) Female pelvic floor: endovaginal MR imaging of normal anatomy. Radiology 206:777–783
Terra MP, Beets-Tan RG, van der Hulst VP et al (2006) MRI in evaluating atrophy of the external anal sphincter in patients with fecal incontinence. AJR Am J Roentgenol 187:991–999
Terra MP, Deutekom M, Beets-Tan RG et al (2006) Relationship between external anal sphincter atrophy at endoanal magnetic resonance imaging and clinical, functional, and anatomic characteristics in patients with fecal incontinence. Dis Colon Rectum 49:668–678
Tunn R, DeLancey JO, Howard D et al (1999) MR imaging of levator ani muscle recovery following vaginal delivery. Int Urogynecol J Pelvic Floor Dysfunct 10:300–307
Vanbeckevoort D, Van Hoe L, Oyen R et al (1999) Pelvic floor descent in females: comparative study of colpocystodefecography and dynamic fast MR imaging. J Magn Reson Imaging 9:373–377
Wald A (2006) Con: Anorectal manometry and imaging are not necessary in patients with fecal incontinence. Am J Gastroenterol 101:2681–2683
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Fletcher, J.G., Bharucha, A.E., Siddiki, H. (2008). Dynamic MR Imaging of the Pelvic Floor. In: Imaging Pelvic Floor Disorders. Medical Radiology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-71968-7_5
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DOI: https://doi.org/10.1007/978-3-540-71968-7_5
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-71966-3
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