Vanbeckevoort D, Van Hoe L, Oyen R, Ponette E, De Ridder D, Deprest J
Department of Radiology, University Hospitals, Leuven, Belgium.
J Magn Reson Imaging. 1999 Mar;9(3):373-7. doi: 10.1002/(sici)1522-2586(199903)9:3<373::aid-jmri2>3.0.co;2-h.
The purpose of this study was to compare fast dynamic magnetic resonance imaging (MRI) with colpocystodefecography (CCD) in the evaluation of pelvic floor descent in women. Thirty-five women with clinical evidence of pelvic floor descent were studied. A fast single-shot MR sequence was performed in the supine position during pelvic floor relaxation and during maximal pelvic strain. On the same day, a dynamic CCD was performed with the patient seated on a stool-chair. The degree of descent of the bladder, vagina, and anorectal junction was evaluated as the vertical distance between the pubococcygeal line and the bladder base, the vaginal vault, and the anorectal junction, respectively. A bulge of more than 3 cm measured as the distance between the extended line of the anterior border of the anal canal and the tip of the rectocele was interpreted as a rectocele. MRI was compared with CCD during maximal pelvic strain (CCD 1) and during voiding and defecation (CCD II). CCD was considered as the gold standard. Compared with clinical examination, CCD I showed a larger number of involved compartments, except for the middle compartment. CCD II was superior to clinical examination in all cases. In comparison with CCD I and especially CCD II, MRI had a lower sensitivity, especially for the anterior and middle compartment. Even four enteroceles seen on CCD II were not detected by MRI. When CCD I and CCD II were compared, a cystocele, a vaginal vault prolapse, an enterocele, and a rectocele were more readily seen on CCD II than with CCD I. When compared with CCD, supine dynamic MRI is unreliable, especially in the anterior and middle compartment. Even in the detection of enteroceles CCD was superior to MRI. In general, the best results with MRI can be expected for evaluation of the rectum.
本研究的目的是比较快速动态磁共振成像（MRI）与阴道膀胱直肠造影（CCD）在评估女性盆底下降方面的效果。对35名有盆底下降临床证据的女性进行了研究。在盆底放松和最大盆底用力时，于仰卧位进行快速单次激发MR序列检查。同一天，让患者坐在便椅上进行动态CCD检查。膀胱、阴道和肛门直肠交界处的下降程度分别评估为耻骨尾骨线与膀胱底部、阴道穹窿和肛门直肠交界处之间的垂直距离。肛管前缘延长线与直肠膨出尖端之间的距离测量超过3 cm的膨出被解释为直肠膨出。在最大盆底用力时（CCD I）以及排尿和排便时（CCD II），将MRI与CCD进行比较。CCD被视为金标准。与临床检查相比，CCD I显示受累腔室数量更多，但中腔室除外。CCD II在所有病例中均优于临床检查。与CCD I尤其是CCD II相比，MRI的敏感性较低，特别是对于前腔室和中腔室。即使在CCD II上看到的4个小肠膨出，MRI也未检测到。当比较CCD I和CCD II时，在CCD II上比在CCD I上更容易看到膀胱膨出、阴道穹窿脱垂、小肠膨出和直肠膨出。与CCD相比，仰卧位动态MRI不可靠，特别是在前腔室和中腔室。即使在检测小肠膨出方面，CCD也优于MRI。一般来说，MRI在评估直肠方面有望获得最佳结果。
