Department of Radiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Eur Radiol. 2012 Dec;22(12):2806-13. doi: 10.1007/s00330-012-2548-5. Epub 2012 Jul 14.
To prospectively explore the clinical application of diffusion tensor imaging (DTI) and fibre tractography in evaluating the pelvic floor.
Ten patients with pelvic organ prolapse, ten with pelvic floor symptoms and ten asymptomatic women were included. A two-dimensional (2D) spin-echo (SE) echo-planar imaging (EPI) sequence of the pelvic floor was acquired. Offline fibre tractography and morphological analysis of pelvic magnetic resonance imaging (MRI) were performed. Inter-rater agreement for quality assessment of fibre tracking results was evaluated using weighted kappa (κ). From agreed tracking results, eigen values (λ1, λ2, λ3), mean diffusivity (MD) and fractional anisotropy (FA) were calculated. MD and FA values were compared using ANOVA. Inter-rater reliability of DTI parameters was interpreted using the intra-class correlation coefficient (ICC).
Substantial inter-rater agreement was found (κ = 0.71 [95% CI 0.63-0.78]). Four anatomical structures were reliably identified. Substantial inter-rater agreement was found for MD and FA (ICC 0.60-0.91). No significant differences between groups were observed for anal sphincter, perineal body and puboperineal muscle. A significant difference in FA was found for internal obturator muscle between the prolapse group and the asymptomatic group (0.27 ± 0.05 vs 0.22 ± 0.03; P = 0.015).
DTI with fibre tractography permits identification of part of the clinically relevant pelvic structures. Overall, no significant differences in DTI parameters were found between groups.
Diffusion tensor MRI offers new insights into female pelvic floor problems. DTI allows 3D visualisation and quantification of female pelvic floor anatomy. DTI parameters from pelvic floor structures can be reliably determined. No significant differences in DTI parameters between groups with/without prolapse.
前瞻性探讨弥散张量成像（DTI）和纤维束示踪技术在评估盆底中的临床应用。
纳入 10 例盆腔器官脱垂患者、10 例盆底症状患者和 10 例无症状女性。采集盆底二维（2D）自旋回波（SE）回波平面成像（EPI）序列。对盆腔磁共振成像（MRI）进行离线纤维束追踪和形态学分析。采用加权κ（κ）评估纤维追踪结果质量评估的观察者间一致性。从一致的跟踪结果中，计算特征值（λ1、λ2、λ3）、平均扩散系数（MD）和各向异性分数（FA）。采用方差分析比较 MD 和 FA 值。采用组内相关系数（ICC）解释 DTI 参数的观察者间可靠性。
发现观察者间存在实质性一致性（κ=0.71[95%CI 0.63-0.78]）。可靠地识别出 4 种解剖结构。MD 和 FA 具有实质性的观察者间一致性（ICC 0.60-0.91）。各组之间肛门括约肌、会阴体和耻骨直肠肌无显著差异。在脱垂组和无症状组之间，内收肌的 FA 存在显著差异（0.27±0.05 比 0.22±0.03；P=0.015）。
DTI 伴纤维束示踪术可识别部分与临床相关的盆底结构。总体而言，各组之间的 DTI 参数无显著差异。
弥散张量 MRI 为女性盆底问题提供了新的见解。DTI 允许对女性盆底解剖结构进行 3D 可视化和量化。可可靠地确定盆底结构的 DTI 参数。无脱垂/有脱垂组之间的 DTI 参数无显著差异。
