Magnetic resonance imaging and three-dimensional transperineal ultrasound evaluation of pelvic floor dysfunction in symptomatic women: a prospective comparative study
Dahlia O. El-Haieg1,2, Nadia M. Madkour1,2, Mohammad Abd Alkhalik Basha1,2 , Reda A. Ahmad1,2, Somayya M. Sadek1,2, Rania M. Al-Molla1,2, Engy Fathy Tantwy1,2, Hosam Nabil Almassry1,2, Khaled Mohamed Altaher1,2, Nader E. M. Mahmoud1,2, Sameh Abdelaziz Aly3,3
1Zagazig University, Zagazig, Egypt
2Zagazig University, Zagazig, Egypt
3Benha University, Benha, Egypt
Corresponding Author: Mohammad Abd Alkhalik Basha ,Tel: +201099098900, Fax: +201099098900, Email:
Received: January 16, 2019;  Accepted: May 6, 2019.  Published online: May 6, 2019.
To investigate magnetic resonance imaging (MRI) and 3-dimensional transperineal ultrasound (3D-TPUS) features of pelvic floor dysfunction (PFD) in symptomatic women in correlation with digital palpation and to define cut-offs for hiatal dimensions that can predict muscle dysfunction.
This is a prospective study included 73 women with symptoms suggesting PFD. 3D-TPUS, MRI, and digital palpation of levator ani muscle were performed for all patients. Levator hiatal antro-posterior (LHap) diameter and area (LH area) were measured at rest and at maximum muscle contraction.
The reduction in LHap diameter and LH area during contraction was significantly less in women with underactive pelvic floor muscle contraction (UpfmC) than those who have a normal pelvic floor muscle contraction (NpfmC) by digital palpation (p <0.001). Statistically significant positive correlations (p <0.001) were found between Modified Oxford Score (MOS) and 3D-TPUS and MRI regarding the reduction in the LHap diameter (r= 0.8, 0.82, respectively) and LH area (r= 0.6, 0.7, respectively). A reduction in LHap <6.5% on 3D-TPUS and <7.6% on MRI, predicted UpfmC with sensitivities of 46% and 83%, respectively. A reduction in LH area <3.4% on 3D-TPUS and <3.8% on MRI predicted UpfmC with sensitivities of 75% and 88.5%, respectively. MRI was more sensitive in detecting levator avulsion (63%) than 3D-TPUS (27%).
MRI and 3D-TPUS have a strong positive correlation with palpation, and at certain cut-offs for hiatal dimensions, they can be used as complementary and objective tools to improve the accuracy of diagnosis and management planning of PFD.
Keywords: Magnetic resonance imaging; Transperineal ultrasound; Pelvic floor dysfunction; Palpation
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