MRI IN Pelvic Floor Disorders. MAHYAR GHAFOORI M.D. Associate Professor of Radiology. Tehran University Of Medical Sciences. Pelvic floor in Women. Anterior Compartment: Bladder & Urethra Middle Compartment: Uterus & Vagina Posterior Compartment: Anorectal. Normal Anatomy.
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MRIINPelvic Floor Disorders MAHYAR GHAFOORI M.D. Associate Professor of Radiology Tehran University Of Medical Sciences
Pelvic floor in Women • Anterior Compartment: Bladder & Urethra • Middle Compartment: Uterus & Vagina • Posterior Compartment: Anorectal
Reference Lines Pubococcygeal line (PCL): From the inferior border of pubic symphysis to the last coccygeal joint. Level of Pelvic Floor H line: Max. 5 cm From inferior border of pubic symphysis to the posterior wall of the rectum at the level of anorectal junction. AP Width of Levator Hiatus M line:Max. 2 cm Perpendicularly from PCL to the most posterior aspect of H line. Vertical descent of the levator hiatus
Rest Straining Normal
Rest Straining 71 Y/O F: Prolapse & Fecal Incontinence
Prolapse Severity Grading Prolapse of an organ below the PCL: 3 cm or less Mild Between 3 and 6 cm Moderate More than 6 cm Severe
Anorectal Angle Rest 108 - 127° Squeezing Close Defecation Open
Puborectalis Muscle Rest Squeezing Straining
Anterior Compartment Cystocele Urethral Hypermobility
Rest Strain 33mm 0° 18mm 65° 48 Y/O Stress urinary incontinence & frequency
56 Y/O F: Stress urinary incontinence, feeling of incomplete bladder voiding, ODS
Middle Compartment Uterine or Vaginal Vault Prolapse
Rest Straining Defecation 41 Y/O F: Severe uterine prolapse
Rest Defecation 72 Y/O F: Prolapse after Hysterectomy
Anterior Rectocele 45 Y/O F: history of obstructed defecation
Posterior Rectocele During Defecation 41 Y/O F with ODS
Rectocele During Defecation Intrarectal Residue 65 Y/O F: History of incomplete evacuation
IntrarectalInvagination 57 Y/O F: Feeling of incomplete evacuation
Extraanal Invagination (Rectal Prolapse) Rest Progressive Straining 63 Y/O F: Fecal Incontinence, Hx of Hysterectomy
Enterocele Early Defecation Late Defecation 64 Y/O F: Prolapse after Hysterectomy
3 Compartment Prolapse Complete Defecation During Defecation 68 Y/O F: Perineal descent, ODS
3 Compartment Prolapse Rest Squeezing Defecation 62 Y/O F: 3 Compartment Descent
Progressive Straining 65 Y/O F: ODS, Hx of Hysterectomy
Spastic Pelvic Floor Syndrome(Pelvic Floor Uncoordination, Anismus) Functional abnormality. Involuntary, inappropriate & paradoxical contraction of striated pelvic floor musculature: evacuation failure & Constipation. Paradoxical contraction of puborectalis muscle. Puborectalismuscle is hypertrophic & makes an impression on posterior rectal wall during defecation. Etiology is unclear (Abnormal muscle activity, psychologic, cognitive) AnorectalManometry: Increased pressure at rest & during defecation. Pathologic signals at electromyography.
Spastic Pelvic Floor Syndrome Rest Strain 51 Y/O M: ODS
Progressive Straining Rest 68 Y/O F: Excessive straining & incomplete evacuation
The End Mahyar Ghafoori M.D.