de Alba Alvarez Irina, van der Steen Annemarie, Grob Anique T M, van den Noort Frieda
Multi Modality Medical Imaging (M3I), TechMed Centre, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands.
Department of Gynecology, Ziekenhuisgroep Twente, Hengelo, The Netherlands.
Sci Rep. 2025 May 10;15(1):16352. doi: 10.1038/s41598-025-01266-x.
There is damage in the pelvic floor only visible in upright imaging. This damage have not been yet studied. The aim of this research is to assess the difference in levator ani muscle (LAM) damage in supine and upright position by means of MRI scans. Sixty-four patients with minimum stage 2 prolapse of the anterior vaginal wall or uterus, without previous pelvic organ prolapse (POP) surgery were scanned in a MR scanner in supine and upright position. Damage to the pubococcygeus muscle (PCM) and the iliococcygeal muscle (ICM) was scored as none, minor or major. For PCM, a previously established protocol was used. For ICM, a protocol for damage assessment was established and validated in this study, by determining the interclass correlation coefficient (ICC). The new ICM assessment protocol was established with ICC values of 0.68 (0.57-0.77) for supine and 0.81 (0.74-0.86) for upright assessment. 6.3% major ICM damage was found in supine vs. 51.6% in upright position with a significant difference of p < 0.001 for the sign-test. There was an underestimation of ICM damage in 59% of the cases in supine position. PCM damage scoring was not feasible on upright MRI's and therefore only assessed on supine scans. In our POP population we found 53.1% of the women with major damage to either the PCM or ICM and 32.8% with major damage in both, leading to a total of 85.9% of women with major damage to at least one structure. There is a significant difference in LAM damage assessment between supine and upright position. Supine imaging leads to a severe underestimation of ICM damage while for the PCM supine damage assessment remains superior.
盆底损伤仅在直立位成像时可见。这种损伤尚未得到研究。本研究的目的是通过磁共振成像（MRI）扫描评估耻骨直肠肌（LAM）在仰卧位和直立位时损伤的差异。64例阴道前壁或子宫至少为2期脱垂且未接受过盆腔器官脱垂（POP）手术的患者在MRI扫描仪上进行了仰卧位和直立位扫描。耻骨尾骨肌（PCM）和髂尾肌（ICM）的损伤程度分为无、轻度或重度。对于PCM，使用了先前建立的方案。对于ICM，在本研究中通过确定组内相关系数（ICC）建立并验证了损伤评估方案。新的ICM评估方案在仰卧位时ICC值为0.68（0.57 - 0.77），直立位时为0.81（0.74 - 0.86）。仰卧位时发现6.3%的ICM为重度损伤，而直立位时为51.6%，符号检验的p值<0.001，差异有统计学意义。仰卧位时59%的病例存在ICM损伤低估情况。PCM损伤评分在直立位MRI上不可行，因此仅在仰卧位扫描时进行评估。在我们的POP患者群体中，我们发现53.1%的女性PCM或ICM有重度损伤，32.8%的女性两者均有重度损伤，导致共有85.9%的女性至少有一个结构受到重度损伤。仰卧位和直立位之间LAM损伤评估存在显著差异。仰卧位成像导致对ICM损伤的严重低估，而对于PCM，仰卧位损伤评估仍然更优。
