Interrater reliability of assessing levator ani deficiency with 360° 3D endovaginal ultrasound

Abstract

Introduction and hypothesis: Three-dimensional endovaginal ultrasound has been used for evaluation of levator ani muscle deficiency. The aim of this study was to assess interrater agreement/reliability of 3D endovaginal ultrasound for scoring levator ani deficiency (LAD).

Methods: This was a cross-sectional study. Women referred to our urogynecology clinic for different pelvic floor dysfunction symptoms during November 2010-November 2012 were recruited. All patients underwent physical examination, including Pelvic Organ Prolapse Quantification (POP-Q) examination and high-resolution 3D endovaginal ultrasound. The levator muscle was divided into three subgroups based on our prior work: the puboperinealis/puboanalis (PA), puborectalis (PR), and iliococcygeus/pubococcygeus (PV). Subgroups were evaluated in their specific axial plane and were scored according to thickness and detachment from the pubic bone. Scoring was conducted by four raters blinded to case status and to one another's scores.

Results: Ninety patients were recruited. The median age was 52 (range 24-86). Median body mass index (BMI) was 28.08 (range 17.08-51.39). Fifty percent of patients were menopausal. The range of exact agreement for total LAD score was 77-90 %. All the correlation coefficients at the individual sites as well as the overall scores were positive at above 0.63 and significant at <0.0001 level.

Conclusions: Our study demonstrates excellent agreement between raters assessing levator ani muscle deficiency using 3D endovaginal ultrasound. This level of concordance supports the reliability of the 3D endovaginal ultrasound technique and scoring method among raters [corrected].