Hoyte L, Fielding J R, Versi E, Mamisch C, Kolvenbach C, Kikinis R
Department of Obstetrics and Gynecology and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Arch Esp Urol. 2001 Jul-Aug;54(6):532-9.
We report on the comparative 3-dimensional (3D) living female pelvic floor geometry in five women, comparing the volume, morphology, and integrity of the levator sling, and pelvic anatomic relationships among study subjects.
Five women of varying ages, parity, continence, and prolapse status were studied. Two-dimensional (2D) imaging of the pelvic floor organs was performed on each subject in the supine position. Manual segmentation techniques and solid modeling software was used to build 3D models of each patient's pelvic floor structures, which could then be viewed and measured on the computer screen. We measured levator muscle volume, posterior urethro-vesical angle, distance from the urethra to pubo-coccygeal line, and the levator plate angle. The integrity of pubo-coccygeal attachments was also recorded.
Levator muscle volume ranged from 68 ml in the nulliparous female, to 26 ml in the grand multipara with severe prolapse and mild genuine stress incontinence (GSI). The second lowest volume (30 ml) was in the multipara with GSI. Volumes in the parous subjects without stress urinary incontinence or pelvic organ prolapse were 36 and 39 ml. Pubo-coccygeal attachments were found to be torn in the 2 symptomatic subjects, and were intact in all 3 asymptomatic subjects.
MR based 3D modeling is feasible and can be used in a research setting to evaluate complex anatomic relationships which may accompany pelvic floor dysfunction. The technique can also be used to evaluate levator muscle morphology and volume, as well as pelvic floor support integrity and its possible role in GSI and prolapse. We are currently conducting a larger study to validate our technique, and to better define the relationship between pelvic floor geometry and pelvic floor dysfunction.
我们报告了五名女性盆底三维（3D）活体几何结构，比较了提肌吊带的体积、形态和完整性，以及研究对象之间的盆腔解剖关系。
研究了五名年龄、产次、尿失禁和脱垂状态各异的女性。对每位仰卧位的受试者进行盆底器官的二维（2D）成像。使用手动分割技术和实体建模软件构建每位患者盆底结构的3D模型，然后可以在电脑屏幕上查看和测量。我们测量了提肌体积、后尿道膀胱角、尿道到耻骨尾骨线的距离以及提肌板角。还记录了耻骨尾骨附着的完整性。
提肌体积范围从未生育女性的68毫升到患有严重脱垂和轻度真性压力性尿失禁（GSI）的多产女性的26毫升。第二低的体积（30毫升）出现在患有GSI的经产妇中。没有压力性尿失禁或盆腔器官脱垂的经产妇的体积分别为36毫升和39毫升。在2名有症状的受试者中发现耻骨尾骨附着撕裂，在所有3名无症状的受试者中均完整。
基于磁共振成像的3D建模是可行的，可用于研究环境中评估可能伴随盆底功能障碍的复杂解剖关系。该技术还可用于评估提肌形态和体积，以及盆底支撑的完整性及其在GSI和脱垂中的可能作用。我们目前正在进行一项更大规模的研究，以验证我们的技术，并更好地定义盆底几何结构与盆底功能障碍之间的关系。
