Shen Lifan, Bai Huijun, Sun Xueyu, Liu Ping, Chen Chunlin
Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Department of Gynecology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China.
Gynecol Obstet Invest. 2025 May 28:1-11. doi: 10.1159/000546464.
This study aimed to combine dynamic magnetic resonance imaging (MRI) with three-dimensional (3D) reconstruction and form a plane based on osseous structures to evaluate the degree of pelvic organ prolapse (POP). The correlation of this novel evaluation approach with the POP-Q system was assessed.
A retrospective analysis was conducted on 71 POP patients with POP-Q stage ≥II. The dynamic MRI images of those patients were reconstructed in three dimensions. A plane was created by using the midpoint of the line between the inferior margins of the two pubic bones and the starting points of the superior margins of the bilateral sacrotuberous ligaments (the pubic inferior midpoint - sacrotuberous ligament starting point superior edge plane). Distances from the lowest point of the anterior vaginal wall, cervix, and rectal ampulla to this evaluation plane were measured, modeled, and categorized. The consistency and correlation of the categorized results with POP-Q scores were verified by performing a kappa analysis and Spearman's rank correlation analysis, respectively.
The highest consistency with POP-Q scores was found in the prolapse of the central pelvic cavity (kappa = 0.713, p < 0.05), followed by the anterior POP (kappa = 0.427, p < 0.05), and posterior POP (kappa = 0.261, p < 0.05), with all showing statistically significant differences. The strongest positive correlation was observed between central POP and POP-Q scores (r = 0.864, p < 0.01), followed by posterior POP and POP-Q scores (r = 0.710, p < 0.01), with both exhibiting a strong positive correlation. Anterior POP and POP-Q scores showed a moderate positive correlation (r = 0.586, p < 0.01).
The results of the proposed evaluation method were highly consistent in the anterior and central pelvic cavities and strongly correlated in the central and posterior pelvic cavities. In particular, the assessment of the posterior cavity showed a strong positive correlation with that of the POP-Q system. The evaluation plane demonstrated high consistency and correlation with the POP-Q system.
本研究旨在将动态磁共振成像（MRI）与三维（3D）重建相结合，基于骨性结构形成一个平面，以评估盆腔器官脱垂（POP）的程度。评估这种新型评估方法与POP-Q系统的相关性。
对71例POP-Q分期≥II期的POP患者进行回顾性分析。对这些患者的动态MRI图像进行三维重建。利用两侧耻骨下缘连线的中点和双侧骶结节韧带前缘的起点创建一个平面（耻骨下中点-骶结节韧带起点上缘平面）。测量、建模并分类阴道前壁最低点、宫颈和直肠壶腹到该评估平面的距离。分别通过kappa分析和Spearman等级相关分析验证分类结果与POP-Q评分的一致性和相关性。
盆腔中央脱垂与POP-Q评分的一致性最高（kappa = 0.713，p < 0.05），其次是前盆腔脱垂（kappa = 0.427，p < 0.05）和后盆腔脱垂（kappa = 0.261，p < 0.05），均显示出统计学显著差异。盆腔中央脱垂与POP-Q评分之间观察到最强的正相关（r = 0.864，p < 0.01），其次是后盆腔脱垂与POP-Q评分（r = 0.710，p < 0.01），两者均表现出强正相关。前盆腔脱垂与POP-Q评分呈中度正相关（r = 0.586，p < 0.01）。
所提出的评估方法在前盆腔和盆腔中央的结果高度一致，在盆腔中央和后盆腔的相关性很强。特别是后盆腔的评估与POP-Q系统的评估显示出强正相关。该评估平面与POP-Q系统显示出高度的一致性和相关性。
