From 2008 to 2011,
2711 patients with symptoms related to pelvic floor dynamic dysfunctions were enrolled in a retrospective study.
Male patients,
that represented about 10% of cases,
were excluded from the study.
The mean age of women in the study was of 57,3.
Patients were divided into three groups: nulliparous,
multiparous and women with prior hysterectomy.
Referral symptoms varied from constipation and obstructed defecation to incontinence.
After anamnesis and clinical examination entero-colpo-cysto-defecography (ECCD) was performed in all patients,
supine entero-MRI (SE-MRI) in patients with positive ECCD findings.
Both examinations were analyzed by two expertise investigators blinded against either the clinical data and the result of the other imaging technique.
Chi-square analyses was used to evaluate the association between each risk factor and defecographic abnormalities.
Imaging technique
Entero-colpo-cysto-defecography
No bowel preparation was used for ECCD.
In order to obtain small-bowel contrast,
1 h before the examination,
200 mL of barium sulfate 60% p/v was administered to each patient,
400 cc of iodine contrast medium (Ultravist,
Bayer Schering Pharma,
Berlin,
Germany) was injected through urinary catheterization until the patient felt a sensation of fullness.
Afterwards,
the patient was placed in left lateral recumbent position,
in order to inject 200 cc of barium paste (Prontobario Esofago 113%,
barium paste,
Bracco,
Milan,
Italy) into the rectum.
During injector removal,
the
anal canal was contrasted,
too.
The vagina was contrasted with 25 ml of barium paste.
Then,
the fluoroscopic table was tilted upright 90°,
and the patient was placed seated on a radiolucent commode.
An anteroposterior radiograph was taken with the patient at rest; after that,
five lateral radiographs were taken at rest,
during the following phases: abdominal straining,
pushing,
evacuating,
and at rest after evacuation.
Dynamic MR defecography
SE-MRI was performed after ECCD in the same day.
All SE-MRI imaging studies were performed on a 1.5-T closed magnet (Magnetom Symphony,
Siemens,
Germany).
All patients were imaged supine (recumbent) with a body-phased-array receiver coil.
To ensure an adequate bladder filling,
all patients were invited to drink 500–700 ml of water 10–15 min before the examination.
The rectum and the vagina were filled with 200 mL and about 25–30 mL ,
respectively,
with ultrasonographic gel.
After an initial localizer in three different planes,
the study protocol included the following MR imaging sequences: TSE T2-W axial (matrix,
181×256; slices,
25; thickness,
5 mm; TR/TE,
6,430/114; flip angle,
180°),
TSE T1-W sagittal (matrix,
181×256; slices,
25; thickness,
5 mm; TR/TE,
846/11; flip angle,
150°),
and functional dynamic sequences TRUFISP T2-W sagittal,
during straining,
pushing,
and evacuation (matrix,
181×256; slices,
1; thickness,
8 mm; TR/TE,
3.75/ 1.6; flip angle,
80°).
The SE-MRI images obtained were assembled in cineview in postprocessing.
The examination time took about 30 min.