Alt Céline D, Brocker Kerstin A, Lenz Florian, Sohn Christof, Kauczor Hans-Ulrich, Hallscheidt Peter
Department of Diagnostic and Interventional Radiology, University of Heidelberg Medical School, Heidelberg, Germany.
Acta Radiol. 2014 May;55(4):495-504. doi: 10.1177/0284185113497201. Epub 2013 Aug 12.
Therapeutical outcome after prolapse surgery is evaluated using a standardized grading system based on maximum prolapse extent, which might not provide the full picture of the patient's subjective outcome. We therefore applied an evaluation method, which is detached from a grading system.
To evaluate the impact of pelvic organ mobility in dynamic magnetic resonance imaging (MRI) before and after mesh-repair surgery in patients with symptomatic pelvic organ prolapse.
To obtain measurements, we performed parasagittal T2-weighted turbo spin echo sequence at rest (TR, 3460 ms; TE, 85 ms; matrix, 512; slice thickness [ST], 5 mm), parasagittal T2-weighted true fast imaging with steady-state precession (TrueFISP) single-shot sequence during straining (TR, 397.4 ms; TE, 1.5 ms; matrix, 256; ST, 8 mm), and parasagittal T2-weighted TrueFISP sequence at maximum strain (TR, 4.3 ms; TE, 2.15 ms; matrix, 256; ST, 5 mm) at 1.5 T MRI. Pelvic organ prolapse (anatomical landmarks: bladder, cervix, pouch, rectum) was measured perpendicularly with reference to the pubococcygeal and the midpubic line. Pelvic organ mobility was defined as the difference between the measured distance at rest and at maximum strain for each anatomical landmark. All patients underwent mesh-repair procedure. Eighty patients could be included in this short-term follow-up study. Due to the physical diagnosis of pelvic organ prolapse, 51 underwent anterior mesh repair, 16 underwent posterior mesh repair, and 13 underwent total mesh repair. Surgery was performed by one surgeon, using mesh implants from several manufacturers.
Median values of maximum organ prolapse for bladder, cervix, pouch, and rectum preoperatively were 2.54 cm, 0.33 cm, 2.47 cm, and 0.32 cm, respectively, and 12 weeks postoperatively 0.87 cm, -1.79 cm, 1.49 cm, and 0.49 cm, respectively. Highly significant improvement (P < 0.001) of pelvic organ mobility was observed in the treated compartment at 4- and 12-week follow-up. Physical evaluation 12 weeks after mesh-repair showed an asymptomatic POP-Q stage I, if any.
Dynamic MRI is useful in visualizing the maximum extent of pelvic organ prolapse, as the evaluation of pelvic organ mobility documents the intraindividual therapeutic outcome detached from a grading system based on maximal prolapse values.
脱垂手术后的治疗效果是使用基于最大脱垂程度的标准化分级系统进行评估的，这可能无法全面反映患者的主观治疗效果。因此，我们应用了一种与分级系统无关的评估方法。
评估有症状的盆腔器官脱垂患者在网状修补手术前后，动态磁共振成像（MRI）中盆腔器官活动度的影响。
为了进行测量，我们在1.5T MRI上，于静息状态下采用矢状位T2加权快速自旋回波序列（TR，3460ms；TE，85ms；矩阵，512；层厚[ST]，5mm），在用力时采用矢状位T2加权稳态进动快速成像（TrueFISP）单次激发序列（TR，397.4ms；TE，1.5ms；矩阵，256；ST，8mm），以及在最大应变时采用矢状位T2加权TrueFISP序列（TR，4.3ms；TE，2.15ms；矩阵，256；ST，5mm）。盆腔器官脱垂（解剖标志：膀胱、宫颈、直肠子宫陷凹、直肠）是相对于耻骨尾骨线和耻骨中线垂直测量的。盆腔器官活动度定义为每个解剖标志在静息和最大应变时测量距离的差值。所有患者均接受了网状修补手术。80例患者可纳入本短期随访研究。由于盆腔器官脱垂经体格检查确诊，51例行前路网状修补术，16例行后路网状修补术，13例行全网状修补术。手术由一名外科医生进行，使用了多家制造商生产的松解植入物。
膀胱、宫颈、直肠子宫陷凹和直肠术前最大器官脱垂的中位数分别为2.54cm、0.33cm、2.47cm和0.32cm，术后12周分别为0.87cm、-1.79cm、1.49cm和0.49cm。在4周和12周随访时，治疗部位的盆腔器官活动度有高度显著改善（P<0.001）。网状修补术后12周的体格检查显示，如有脱垂则为无症状的盆腔器官脱垂定量分期I期。
动态MRI有助于观察盆腔器官脱垂的最大程度，因为盆腔器官活动度的评估记录了与基于最大脱垂值的分级系统无关的个体内治疗效果。
