Pelvic floor imaging with MR defecography: correlation with gynecologic pelvic organ prolapse quantification
Pelvic floor imaging with MR defecography: correlation with gynecologic pelvic organ prolapse quantification
复制标题
DOI：
10.1007/s00261-020-02476-9
复制
发表时间：
2020-03-24
影响因子：
2.4
通讯作者：
Ram, Roopa
中科院分区：
文献类型：
--
作者：
Swamy, Nayanatara;Bajaj, Gitanjali;Ram, Roopa
目的：妇科医生和放射科医生对盆腔器官脱垂（POP）的评价不同。它通过使用POP-Q（盆腔器官脱垂量化）系统进行体格检查进行临床分期，并通过磁共振排粪造影（MRD）等方式进行放射学分期。本研究的目的是通过比较相关的解剖学点和技术上的差异，将两种盆腔器官脱垂分期方法在每个盆腔隔室中的相关性联系起来。这种理解将有助于从两个不同的角度综合信息，并弥合参与复杂盆底疾病患者护理的多名专家之间的差距。方法回顾性单机构研究比较在我们的医疗中心进行动态磁共振盆底成像和盆腔器官脱垂定量（POP-Q）的患者。两名妇科泌尿科医生进行POP-Q，一名接受过研究员培训的放射科医生解释MRD，两人都独立地对盆腔器官脱垂进行分期。结果2013年1月至2017年12月共280例患者接受了骨盆底磁共振成像（MRI）检查，其中68例符合纳入标准。与POP-Q相比，MRI对前室、中室和后室脱垂的量化分别具有强、中等和弱相关性。POP-Q测量值Aa、Ba、C和D类似于通过MRI可直接且一致地测量的真实盆腔解剖标志，因此与与真实解剖标志不相关的测量值Ap和Bp相比，可以解释前室和中室中更好的相关性，因此可以解释后室脱垂的弱相关性。结论POP-Q与MRI比较，前、中室脱垂的相关性优于后室脱垂。通过临床检查和成像标准对盆腔器官脱垂进行分期的技术和解剖标志存在固有差异。然而，MRD仍然提供静态图像上的解剖细节，多间室脱垂的真实的时间同步概览，在动态成像上表征盲囊疝和直肠排空的内容物。从两种器官分期方法中获得的确证信息将导致最佳的患者护理。
Purpose 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. Methods 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. Results 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. Conclusion 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.