Learning objectives
Demonstrate the great contrast resolution of MRI in direct visualization of anatomic pelvic structures as well the functional assessment of the pelvic floor
Describe a number of reference lines and measurement points used to diagnose and grade pelvic floor disorders
Document the MRI appearance of disorders associated with ano-rectal dysfunction
Evaluate the role of magnetic resonance (MRI) in identification of diseases affecting the ano-rectal evacuation mechanism
Every MRI image shown in this presentation belongs to cases from our institution.
Since we did not experience patients...
Background
Introduction
Pelvic floor disorders represents a common health problem
Women are more affected
Advanced age,
multiparty,
obesity,
smoke,
previous pelvic surgery,
constipation,
genetic factors,
heavy physical exertion contributes to this problem
Symptoms are variable and nonspecific
Clinical evaluation of these disorders is insufficient
Radiologic evaluation should be preceded by:
Clinical history – symptom duration,
severity
Physical examination
Clinical background - obstetric trauma,
surgeries,
inflammation,
infections,
Inflamatory Bowel Disease,
fistulas,
others
Colonoscopy/rectosygmoidoscopy
Functional tests
Others
It is always imperative to exclude an organic cause,
especially involving...
Findings and procedure details
Morphologic Abnormalities
Rectocele – bulging of the anterior rectal wall against the posterior vaginal wall.
Small rectoceles are frequent in asymptomatic women and may represent a normal variant.
Large rectoceles (> 2 cm) have a strong association with evacuation difficulty.
Rectoceles may contribute to passive leakage after incomplete evacuation.
Herniation of the pelvic peritoneal sac through the recto-genital space below de pubo-coccigeal ligament or recto-vaginal septum at the level or below the lower third of the vagina; it may contain fat (peritoneocele),
small bowel or...
Conclusion
MRI is a non-invasive,
non-ionizing radiation technique,
which can be an important auxilliary tool for pelvic floor anatomy and functional evaluation,
thanks to its extraordinary capabilities regarding tissue contrast
It is a technique that,
when adequately integrated with prior clinical evaluation and exclusion of organic disease,
may have na invaluable role in the diagnosis,
therapeutic guidance and follow-up of pelvic floor dysfunction disorders
Magnetic resonance permits evaluation of the three pelvic compartments and,
as we demonstrated,
more than one compartment are frequently affected
Assessment of...
References
Li M,
et al.
Association of compartment defects in anorectal and pelvic floor dysfunction with female outlet obstruction constipation (OOC) by dynamic MR defecography.
European review for medical and pharmacological sciences (2015) 19: 1407-1415
Aminah NA,
et al.
review of functional pelvic floor imaging modalities and their effectiveness.
Clinical Imaging (2015)
Khatri G.
Magnetic resonance imaging of pelvic floor disorders.
Topics in magnetic resonance imaging (2014) 23 (4): 259-273
Pizzoferrato A-C,
et al.
Dynamic magnetic resonance imaging and pelvic floor disorders: how and when?.
European...