Pannu Harpreet K, Scatarige John C, Eng John
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
J Comput Assist Tomogr. 2009 Jan-Feb;33(1):125-30. doi: 10.1097/RCT.0b013e318161d739.
To compare supine magnetic resonance imaging (MRI), with and without rectal contrast, with fluoroscopic cystocolpoproctography (CCP) for the diagnosis of pelvic organ prolapse.
Supine MRI and CCP studies were reviewed in 82 patients. All patients were women with an average age of 58.8 years, and the studies were done a mean of 25 days apart. Magnetic resonance imaging was performed with rectal contrast (n = 35) and without rectal contrast (n = 47). Fluoroscopic cystocolpoproctography was performed with rectal (n = 82), vaginal (n = 82), small bowel (n = 81), and bladder (n = 78) contrast, and images were corrected for magnification. Each study was independently reviewed by 2 readers, and outcome variables were presence/absence of cystocele, vaginal prolapse, enterocele, sigmoidocele, and anterior rectocele. Sigmoidoceles were included with enteroceles for data analysis.
For the entire patient group, the prevalence of cystoceles was 89% on CCP and 80% on MRI; vaginal prolapse was 81% on CCP and 56% on MRI; enteroceles, 38% on CCP and 24% on MRI; and anterior rectoceles, 45% on CCP and 37% on MRI. There were significantly more cystoceles (odds ratio [OR] 4.7, P = 0.003), vaginal prolapses (OR 5.2, P < 0.0005), and enteroceles (OR 3.8, P< 0.0005) on CCP than on MRI. For MRI with rectal contrast versus CCP, the prevalence of cystoceles was 94% on CCP and 91% on MRI; vaginal prolapse, 74% on CCP and 70% on MRI; enteroceles, 36% on CCP and 19% on MRI; and anterior rectoceles, 51% on CCP and 59% on MRI. There was statistical significance only for enteroceles, more of which were found on CCP (OR 7.4, P = 0.003). For MRI without rectal contrast versus CCP, the prevalence of cystoceles was 85% on CCP and 72% on MRI; vaginal prolapse, 86% on CCP and 46% on MRI; enteroceles, 40% on CCP and 28% on MRI; and anterior rectoceles, 39% on CCP and 21% on MRI. There were significantly more cystoceles (OR 6.6, P = 0.003), vaginal prolapses (OR 20.8, P < 0.0005), enteroceles (OR 2.9, P = 0.015), and rectoceles (OR 4.9, P = 0.001) on CCP than on noncontrast MRI.
Magnetic resonance imaging without rectal contrast showed statistically fewer pelvic floor abnormalities than CCP. Except for enteroceles, MRI with rectal contrast showed statistically similar frequency of pelvic organ prolapse as CCP.
比较仰卧位磁共振成像（MRI）（有无直肠造影剂）与荧光透视膀胱阴道直肠造影术（CCP）在诊断盆腔器官脱垂方面的效果。
回顾性分析82例患者的仰卧位MRI和CCP检查结果。所有患者均为女性，平均年龄58.8岁，两项检查平均间隔25天进行。MRI检查中，35例使用直肠造影剂，47例未使用。荧光透视膀胱阴道直肠造影术检查时均使用直肠（82例）、阴道（82例）、小肠（81例）和膀胱（78例）造影剂，并对图像进行放大校正。每项检查由2名阅片者独立评估，观察指标包括膀胱膨出、阴道脱垂、肠膨出、乙状结肠膨出和直肠前膨出的有无。数据分析时将乙状结肠膨出纳入肠膨出。
在整个患者组中，CCP检查显示膀胱膨出的患病率为89%，MRI为80%；阴道脱垂CCP为81%，MRI为56%；肠膨出CCP为38%，MRI为24%；直肠前膨出CCP为45%，MRI为37%。CCP检查发现的膀胱膨出（优势比[OR] 4.7，P = 0.003）、阴道脱垂（OR 5.2，P < 0.0005）和肠膨出（OR 3.8，P< 0.0005）均显著多于MRI。对于使用直肠造影剂的MRI与CCP，膀胱膨出的患病率CCP为94%，MRI为91%；阴道脱垂CCP为74%，MRI为70%；肠膨出CCP为36%，MRI为19%；直肠前膨出CCP为51%，MRI为59%。仅肠膨出有统计学差异，CCP发现的更多（OR 7.4，P = 0.003）。对于未使用直肠造影剂的MRI与CCP，膀胱膨出的患病率CCP为85%，MRI为72%；阴道脱垂CCP为86%，MRI为46%；肠膨出CCP为40%，MRI为28%；直肠前膨出CCP为39%，MRI为21%。CCP检查发现的膀胱膨出（OR 6.6，P = 0.003）、阴道脱垂（OR 20.8，P < 0.0005）、肠膨出（OR 2.9，P = 0.015）和直肠膨出（OR 4.9，P = 0.001）均显著多于未使用造影剂的MRI。
未使用直肠造影剂的MRI显示的盆底异常在统计学上少于CCP。除肠膨出外，使用直肠造影剂的MRI显示的盆腔器官脱垂频率在统计学上与CCP相似。
