Chi Tony Wing-Cheong, Chen Shin-Hong
Department of Radiology, Min-Sheng General Hospital, Taipei, Taiwan.
Kaohsiung J Med Sci. 2007 Jun;23(6):302-8. doi: 10.1016/S1607-551X(09)70413-9.
Prolapse of pelvic organs in a female can be simple or complex. To make a definite diagnosis of pelvic prolapse preoperatively, dynamic magnetic resonance (MR) is an alternative to conventional fluoroscopic or sonographic examination, with the advantage of providing greater details, and thus helping the surgeon to have a good preoperative plan. Nine women suffering from pelvic prolapse with or without urinary stress incontinence underwent dynamic MR imaging examination (1.0T Magnex100/HP, Shimadzu, Kyoto, Japan) before surgery. All patients were examined in the supine position. A single-shot ultra-high speed scan (FE/8/3.02-20 degrees, 128, 100%-100% 1 NEX 1 slice 10 mm L1.0 second) was used to obtain midline sagittal images, with the patients at rest and during pelvic strain. MR images were then obtained every 4 seconds. Each examination was analyzed, based on specific measurements, to determine the presence and extent of prolapse of pelvic organs. The pubococcygeal, levator hiatus width and muscular pelvic floor relaxation lines, and the angle of the levator plate were identified. Based on these measurements, multicompartment involvement in the pelvic prolapse was confirmed in five patients (5/9). Four patients (4/9) had single compartment involvement. Seven patients underwent surgery. All patients reported significant improvement in their symptoms and signs after surgical intervention. Two patients had an almost complete recovery. MR demonstrated simple or complex organ descent in all pelvic compartments, and may become a standard preoperative examination for pelvic floor abnormalities. The MR images facilitated comprehensive planning by the surgeon; thus, they can increase the success rate and help to accurately predict the outcome of the surgical intervention. The surgeons also expressed high postsurgical satisfaction with the information provided by dynamic MR.
女性盆腔器官脱垂可分为单纯性或复杂性。为在术前对盆腔脱垂做出明确诊断，动态磁共振成像（MR）可替代传统的荧光镜检查或超声检查，其优点是能提供更多细节，从而帮助外科医生制定良好的术前计划。9例患有盆腔脱垂伴或不伴压力性尿失禁的女性在手术前行动态MR成像检查（1.0T Magnex100/HP，日本岛津公司，京都）。所有患者均取仰卧位进行检查。采用单次激发超高速扫描（快速自旋回波/8/3.02 - 20度，128，100% - 100% 1次采集1层10mm L1.0秒）获取患者静息及盆腔用力时的中线矢状面图像。然后每4秒获取一次MR图像。基于特定测量对每次检查进行分析，以确定盆腔器官脱垂的存在及程度。确定耻骨直肠肌、提肌裂孔宽度和盆底肌肉松弛线以及提肌板角度。基于这些测量，证实5例患者（5/9）存在多腔室盆腔脱垂。4例患者（4/9）为单腔室受累。7例患者接受了手术。所有患者术后症状和体征均有显著改善。2例患者几乎完全康复。MR显示所有盆腔腔室均存在单纯性或复杂性器官下移，可能成为盆底异常的标准术前检查。MR图像有助于外科医生进行全面规划；因此，可提高成功率并有助于准确预测手术干预的结果。外科医生对动态MR提供的信息术后满意度也很高。
