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: Mohammad_basha76@yahoo.com
Received: January 16, 2019;  Accepted: May 6, 2019.  Published online: May 6, 2019.
ABSTRACT
Purpose:
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.
Methods:
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.
Results:
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%).
Conclusion:
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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