Grob Anique T M, Olde Heuvel Judith, Futterer Jurgen J, Massop Diana, Veenstra van Nieuwenhoven Angelique L, Simonis Frank F J, van der Vaart Carl H
MultiModality Medical Imaging (M3i), Technical Medical Centre, University of Twente, Carre Building, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands.
Magnetic Detection and Imaging (MD&I), Technical Medical Centre, University of Twente, Enschede, The Netherlands.
Int Urogynecol J. 2019 Nov;30(11):1939-1944. doi: 10.1007/s00192-018-03862-0. Epub 2019 Jan 17.
Pelvic organ prolapse (POP) is clinically diagnosed in the supine position, where the effect of gravity is simulated by having the patients put strain on their pelvic floor. The objective of this study was to determine the degree of POP underestimation in the supine position based on magnetic resonance imaging (MRI) findings.
This prospective study was conducted with symptomatic POP grade ≥ 2 patients. Fifteen female patients were examined with an MRI system that allows supine and upright imaging. The differences between supine and upright in distances of the bladder neck, cervix, and pouch of Douglas from the pubococcygeal line (PCL) were estimated, together with changes in the genital hiatal area. Patients were scanned at rest and during straining. All distances were compared using the Wilcoxon ranking test.
All mean distances from the PCL increased from the supine-strain to the upright-rest and from the supine-strain to the upright-strain position. These distances were found in the supine and upright positions: the bladder descended 1.3 cm to 1.4 cm, the cervix 1.1 cm to 2.2 cm, and the pouch of Douglas 0.8 cm to 1.5 cm respectively (all p values <0.05). The hiatal area was larger in the upright-strain position (mean 42.0 cm; SD ±14.8) than during the supine-strain position (mean 33.5 cm; SD ±14.5), with a p value of 0.02.
Upright MRI scanning of patients with POP grade ≥ 2 both at rest and during straining shows a significantly larger extent of the prolapse than that observed during supine straining.
盆腔器官脱垂（POP）是在仰卧位进行临床诊断的，通过让患者对盆底施加压力来模拟重力的影响。本研究的目的是根据磁共振成像（MRI）结果确定仰卧位时POP低估的程度。
本前瞻性研究针对有症状的POP分级≥2级的患者进行。15名女性患者接受了可进行仰卧位和直立位成像的MRI系统检查。估计了膀胱颈、宫颈和Douglas窝在仰卧位和直立位时距耻骨尾骨线（PCL）的距离差异，以及生殖裂孔面积的变化。患者在静息状态和用力时进行扫描。所有距离均使用Wilcoxon秩和检验进行比较。
从仰卧位用力到直立位静息以及从仰卧位用力到直立位用力时，所有距PCL的平均距离均增加。在仰卧位和直立位时发现这些距离分别为：膀胱下降1.3 cm至1.4 cm，宫颈下降1.1 cm至2.2 cm，Douglas窝下降0.8 cm至1.5 cm（所有p值<0.05）。直立位用力时的裂孔面积（平均42.0 cm；标准差±14.8）大于仰卧位用力时（平均33.5 cm；标准差±14.5），p值为0.02。
对POP分级≥2级的患者在静息和用力时进行直立位MRI扫描显示，脱垂程度明显大于仰卧位用力时观察到的程度。
