Comiter C V, Vasavada S P, Barbaric Z L, Gousse A E, Raz S
Department of Urology, University of California, Los Angeles School of Medicine, 90024, USA.
Urology. 1999 Sep;54(3):454-7. doi: 10.1016/s0090-4295(99)00165-x.
With significant vaginal prolapse, it is often difficult to differentiate among cystocele, enterocele, and high rectocele by physical examination alone. Our group has previously demonstrated the utility of magnetic resonance imaging (MRI) for evaluating pelvic prolapse. We describe a simple objective grading system for quantifying pelvic floor relaxation and prolapse.
One hundred sixty-four consecutive women presenting with pelvic pain (n = 39) or organ prolapse (n = 125) underwent dynamic MRI. The "H-line" (levator hiatus) measures the distance from the pubis to the posterior anal canal. The "M-line" (muscular pelvic floor relaxation) measures the descent of the levator plate from the pubococcygeal line. The "O" classification (organ prolapse) characterizes the degree of visceral prolapse beyond the H-line.
The image acquisition time was 2.5 minutes per study. Each study cost $540. In the pain group, the H-line averaged 5.2 +/- 1.1 cm versus 7.5 +/- 1.5 cm in the prolapse group (P <0.001). The M-line averaged 1.9 +/- 1.2 cm in the pain group versus 4.1 +/- 1.5 cm in the prolapse group (P <0.001). Incidental pelvic pathologic features were commonly noted, including uterine fibroids, ovarian cysts, hydroureter, urethral diverticula, and foreign body.
The HMO classification provides a straightforward and reproducible method for staging and quantifying pelvic floor relaxation and visceral prolapse. Dynamic MRI requires no patient preparation and is ideal for the objective evaluation and follow-up of patients with pelvic prolapse and pelvic floor relaxation. MRI obviates the need for cystourethrography, pelvic ultrasound, or intravenous urography and has become the study of choice at our institution for evaluating the female pelvis.
对于严重阴道脱垂，仅通过体格检查往往难以区分膀胱膨出、肠膨出和高位直肠膨出。我们团队之前已证明磁共振成像（MRI）在评估盆腔脱垂方面的实用性。我们描述了一种简单的客观分级系统，用于量化盆底松弛和脱垂情况。
164例连续出现盆腔疼痛（n = 39）或器官脱垂（n = 125）的女性接受了动态MRI检查。“H线”（提肛裂孔）测量从耻骨到肛管后部的距离。“M线”（盆底肌肉松弛）测量提肌板从耻骨尾骨线下降的程度。“O”分类（器官脱垂）描述内脏脱垂超出H线的程度。
每次检查的图像采集时间为2.5分钟。每次检查费用为540美元。疼痛组的H线平均为5.2±1.1厘米，而脱垂组为7.5±1.5厘米（P <0.001）。疼痛组的M线平均为1.9±1.2厘米，而脱垂组为4.1±1.5厘米（P <0.001）。常见偶然发现的盆腔病理特征，包括子宫肌瘤、卵巢囊肿、输尿管积水、尿道憩室和异物。
HMO分类为盆底松弛和内脏脱垂的分期及量化提供了一种直接且可重复的方法。动态MRI无需患者准备，是评估盆腔脱垂和盆底松弛患者的客观评估及随访的理想方法。MRI无需进行膀胱尿道造影、盆腔超声或静脉肾盂造影，已成为我们机构评估女性骨盆的首选检查方法。
