Department of Diagnostic Radiology, University of Arkansas for Medical Sciences, 4301 W Markham Street, Slot #556, Little Rock, AR, 72205-7199, USA.
Urogynecology, CHI St. Vincent Infirmary, 5 St. Vincent Circle, Suite 300, Blandford Bldg., Little Rock, AR, 72205, USA.
Abdom Radiol (NY). 2021 Apr;46(4):1381-1389. doi: 10.1007/s00261-020-02476-9.
Pelvic organ prolapse (POP) is assessed differently by gynecologists and radiologists. It is clinically staged by physical examination using the POP-Q (Pelvic Organ Prolapse Quantification) system and radiologically staged by modalities such as by Magnetic Resonance Defecography (MRD). The purpose of this study was to correlate the two methods of staging pelvic organ prolapse for each pelvic compartment by comparing correlative anatomic points and differences in technique. This understanding will help synthesize information from two different perspectives and bridge the gap between multiple specialists who participate in the care of patients with complex pelvic floor disorders.
A retrospective single institution study comparison of patients who underwent both dynamic magnetic resonance pelvic floor imaging and pelvic organ prolapse quantification (POP-Q) at our medical center was done. Two urogynecologists performed the POP-Q and one fellowship-trained radiologist interpreted the MRD and both staged pelvic organ prolapse independently.
A total of 280 patients underwent magnetic resonance imaging (MRI) of the pelvic floor from 1/2013 to 12/2017, of whom 68 met our inclusion criteria. When compared to POP-Q, MRI has strong, moderate, and weak correlation for quantification of anterior, middle, and posterior compartment prolapse, respectively. POP-Q measurements Aa, Ba, C, and D are analogous to true pelvic anatomical landmarks which are directly and consistently measurable by MRI, hence accounting for the better correlation in anterior and middle compartments when compared to measurements Ap and Bp which do not correlate with true anatomical landmarks, and hence can explain the weak correlation for posterior compartment prolapse.
When comparing POP-Q to MRI, anterior and middle compartment prolapse have better correlation than posterior compartment prolapse. Inherent differences that exist in technique and anatomic landmarks used for staging pelvic organ prolapse by clinical exam and imaging criteria account for this. MRD, however, still provides anatomic details on static images, real time simultaneous overview of multi-compartmental prolapse, characterizes contents of cul-de-sac hernias and rectal evacuation on dynamic imaging. Corroborative information derived from both methods of staging organ will result in optimum patient care.
妇科医生和放射科医生对盆腔器官脱垂（POP）的评估方式不同。临床上通过使用盆腔器官脱垂量化（POP-Q）系统进行体格检查来对其进行分期，放射学上则通过磁共振排粪造影（MRD）等方式进行分期。本研究的目的是通过比较相关解剖点和技术差异，对每个盆腔隔室的盆腔器官脱垂的两种分期方法进行相关性分析。这种理解将有助于综合来自两个不同视角的信息，并弥合参与治疗复杂盆底功能障碍患者的多个专业人员之间的差距。
对在我院接受动态磁共振盆底成像和盆腔器官脱垂量化（POP-Q）检查的患者进行回顾性单机构研究比较。两位妇科泌尿医生进行 POP-Q 检查，一位接受过 fellowship培训的放射科医生解释 MRD，并独立对盆腔器官脱垂进行分期。
共有 280 名患者于 2013 年 1 月至 2017 年 12 月接受了盆腔磁共振成像（MRI）检查，其中 68 名符合我们的纳入标准。与 POP-Q 相比，MRI 对前、中、后隔室脱垂的量化具有强、中、弱相关性。POP-Q 测量值 Aa、Ba、C 和 D 与真正的盆腔解剖学标志相似，可直接且一致地通过 MRI 测量，因此与真正的解剖学标志不相关的测量值 Ap 和 Bp 相比，前隔室和中隔室的相关性更好，这也可以解释后隔室脱垂的弱相关性。
与 MRI 相比，POP-Q 在前隔室和中隔室脱垂方面的相关性优于后隔室脱垂。这是由于临床检查和影像学标准在分期盆腔器官脱垂时，在技术和解剖学标志上存在固有差异。然而，MRD 仍然可以在静态图像上提供解剖细节，实时同时概述多隔室脱垂，在动态成像上描述疝囊和直肠排空的内容物。从两种分期器官的方法中获得的补充信息将导致最佳的患者护理。
