Welch Eva K, Ross Warren, Dengler Katherine L, Gruber Daniel D, Lamb Shannon
Department of Gynecologic Surgery & Obstetrics Urogynecology Division, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD, 20889, USA.
Department of Radiology, United States Naval Hospital, Okinawa, Japan.
Int Urogynecol J. 2024 Nov;35(11):2223-2225. doi: 10.1007/s00192-024-05935-9. Epub 2024 Sep 28.
Concurrent pelvic organ and rectal prolapse have an incidence of 38%. Dynamic pelvic magnetic resonance imaging (MRI) is the modality of choice for workup. We discuss dynamic pelvic MRI indications, interpretation, and clinical application to pelvic floor disorders.
The pubococcygeal line (PCL) extends from the pubic symphysis to the last coccygeal joint. The "H line" demonstrates the levator hiatus size, drawn from the inferior pubic symphysis to the posterior rectal wall at the anorectal junction. The "M line" represents vertical descent of the levator hiatus and extends perpendicularly from the PCL to the posterior aspect of the H line. With rectovaginal fascial defects, the small bowel, the peritoneum, and the sigmoid colon can prolapse. Posterior compartment abnormalities include rectocele, rectal prolapse, and descending perineal syndrome. Pelvic MRI can evaluate functional disorders such as anismus, where the anorectal angle is narrowed and associated with lack of pelvic floor descent and incomplete evacuation.
Particularly for patients with concurrent urogynecological and colorectal complaints, previous pelvic reconstructive surgery, or when clinical symptomatology does not correlate with physical examination, dynamic pelvic MRI can impact management. It is critical for pelvic reconstructive surgeons to be familiar with this imaging modality to counsel patients and interpret radiographic findings.
盆腔器官与直肠同时脱垂的发生率为38%。动态盆腔磁共振成像（MRI）是检查的首选方式。我们讨论动态盆腔MRI在盆底疾病中的适应证、解读及临床应用。
耻骨尾骨线（PCL）从耻骨联合延伸至最后一个尾骨关节。“H线”显示提肌裂孔大小，从耻骨联合下缘至肛管直肠交界处的直肠后壁绘制。“M线”代表提肌裂孔的垂直下降，从PCL垂直延伸至H线的后侧。存在直肠阴道筋膜缺损时，小肠、腹膜和乙状结肠可能脱垂。后盆腔异常包括直肠膨出、直肠脱垂和会阴下降。盆腔MRI可评估功能性障碍，如盆底失弛缓综合征，此时肛管直肠角变窄，且与盆底下降不足和排空不全相关。
特别是对于同时有泌尿妇科和结直肠问题主诉的患者、既往有盆腔重建手术史的患者，或临床症状与体格检查不相符时，动态盆腔MRI会影响治疗管理。盆腔重建外科医生熟悉这种成像方式对于为患者提供咨询和解读影像学检查结果至关重要。
