Deval B, Vulierme M-P, Poilpot S, Menu Y, Levardon M
Service de Gynécologie Obstétrique, Université Bichat-Beaujon, Hôpital Beaujon, 100, avenue du Général-Leclerc, 92110 Clichy.
J Gynecol Obstet Biol Reprod (Paris). 2003 Feb;32(1):22-9.
Dynamic MR imaging (MRI) may be used as an alternative to dynamic cystoproctography for the evaluation of pelvic floor prolapse. Our study aimed to define the range of dynamic pelvic MRI aspects observed during the exploration of pelvic prolapse.
Fascial and anatomic defects can include a combinaison of cystocele, rectocele, uterine prolapse, enterocele and vault prolapse. Acute diagnosis of the coexisting abnormalities is essential in planning reconstructive procedures so that the risks of recurrence and reoperation can be minimized. At this time colpocystography is the study of choice to evaluate pelvic floor dysfunction. Dynamic magnetic resonance imaging for exploration of pelvic floor dysfunction is under evaluation.
Pubococcygeal line and puborectalis muscle were the references points. The grading system is based on degree of organ prolapse through the hiatus and the degree of pubo-rectalis descent and hiatal enlargement. Unfortunately, there is a real discordance between the reality of the prolapse and its imaging. However, a new reference line, the mid pubic line, was drawn on the magnetic resonance image to correspond to the hymeneal ring marker used in clinical staging. Intra-operative findings were considered the gold standard against which physical examination, dynamic colpocystodefecography and MRI were compared. Using these criteria the sensitivity, specificity and positive predictive value of MRI were 70%, 100%, 100% for cystocele; 42%, 81%, 60% for vaginal vault or uterine prolapse; 100%, 83%, 75% for enterocele; 87%, 72% and 66% for rectocele.
MRI appears to be an important adjunct in the comprehensive evaluation of the female pelvis. Except for vaginal vault, pelvic prolapse is accurately staged and pelvic organ prolapse reliably detected. The technique is rapid, non invasive and cost effective, it allows the clinician to visualize the whole pelvis using a single dynamic study that provides anatomical details.
动态磁共振成像（MRI）可作为动态膀胱直肠造影的替代方法用于评估盆底脱垂。我们的研究旨在明确在盆腔脱垂检查过程中观察到的动态盆腔MRI表现范围。
筋膜和解剖学缺陷可包括膀胱膨出、直肠膨出、子宫脱垂、肠膨出和穹窿脱垂的组合。对并存异常进行准确诊断对于规划重建手术至关重要，这样可以将复发和再次手术的风险降至最低。目前，膀胱阴道造影是评估盆底功能障碍的首选检查方法。用于探索盆底功能障碍的动态磁共振成像正在评估中。
耻骨尾骨线和耻骨直肠肌为参考点。分级系统基于器官通过裂孔脱垂的程度、耻骨直肠肌下降程度和裂孔增大程度。遗憾的是，脱垂的实际情况与其影像学表现之间存在明显差异。然而，在磁共振图像上绘制了一条新的参考线，即耻骨中线，以对应临床分期中使用的处女膜环标记。术中发现被视为金标准，用于与体格检查、动态膀胱直肠造影和MRI进行比较。根据这些标准，MRI对膀胱膨出的敏感性、特异性和阳性预测值分别为70%、100%、100%；对阴道穹窿或子宫脱垂分别为42%、81%、60%；对肠膨出分别为100%、83%、75%；对直肠膨出分别为87%、72%和66%。
MRI似乎是女性骨盆综合评估中的一项重要辅助手段。除阴道穹窿外，盆腔脱垂可准确分期，盆腔器官脱垂可可靠检测。该技术快速、无创且具有成本效益，它使临床医生能够通过一次提供解剖细节的动态检查可视化整个骨盆。
