Department of Radiology, University Medical Center Regensburg, 93042 Regensburg, Germany.
World J Gastroenterol. 2012 Dec 14;18(46):6836-42. doi: 10.3748/wjg.v18.i46.6836.
Evaluation of the wide range of normal findings in asymptomatic women undergoing dynamic magnetic resonance (MR) defecography.
MR defecography of 10 healthy female volunteers (median age: 31 years) without previous pregnancies or history of surgery were evaluated. The rectum was filled with 180 mL gadolinium ultrasound gel mixture. MR defecography was performed in the supine position. The pelvic floor was visualized with a dynamic T2-weighted sagittal plane where all relevant pelvic floor organs were acquired during defecation. The volunteers were instructed to relax and then to perform straining maneuvers to empty the rectum. The pubococcygeal line (PCGL) was used as the line of reference. The movement of pelvic floor organs was measured as the vertical distance to this reference line. Data were recorded in the resting position as well as during the defecation process with maximal straining. Examinations were performed and evaluated by two experienced abdominal radiologists without knowledge of patient history.
Average position of the anorectal junction was located at -5.3 mm at rest and -29.9 mm during straining. The anorectal angle widened significantly from 93° at rest to 109° during defecation. A rectocele was diagnosed in eight out of 10 volunteers showing an average diameter of 25.9 mm. The bladder base was located at a position of +23 mm at rest and descended to -8.1 mm during defecation in relation to the PCGL. The bladder base moved below the PCGL in six out of 10 volunteers, which was formally defined as a cystocele. The uterocervical junction was located at an average level of +43.1 mm at rest and at +7.9 mm during straining. The uterocervical junction of three volunteers fell below the PCGL; described formally as uterocervical prolapse.
Based on the range of standard values in asymptomatic volunteers, MR defecography values for pathological changes have to be re-evaluated.
评估无症状女性行动态磁共振排粪造影时大范围的正常表现。
对 10 名无妊娠史或手术史的健康女性志愿者（中位年龄：31 岁）进行磁共振排粪造影检查。直肠内注入 180ml 钆增强超声凝胶混合物。磁共振排粪造影检查取仰卧位，矢状面 T2 加权像动态观察盆底，在排便过程中获取所有相关的盆底器官。嘱志愿者放松，然后进行排便动作排空直肠。采用耻骨直肠肌线（PCGL）作为参考线，测量盆底器官的运动距离，即与参考线的垂直距离。数据记录在静息状态和最大排便时的收缩状态下。由 2 名具有丰富腹部放射学经验但不了解患者病史的放射科医生进行检查和评估。
静止状态下肛直肠连接处的平均位置为-5.3mm，最大收缩时为-29.9mm。肛直角在静息时为 93°，在排便时显著增宽至 109°。10 名志愿者中有 8 名诊断为直肠前突，平均直径为 25.9mm。膀胱底在静息时位于 PCGL 上方+23mm，在排便时下移至-8.1mm。10 名志愿者中有 6 名膀胱底低于 PCGL，正式定义为膀胱膨出。子宫颈连接部在静息时位于+43.1mm，最大收缩时位于+7.9mm。3 名志愿者的子宫颈连接部低于 PCGL，正式定义为子宫颈脱垂。
基于无症状志愿者的标准值范围，需要重新评估磁共振排粪造影的病理性改变值。
