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. 2016:2016:6594152.
doi: 10.1155/2016/6594152. Epub 2016 Jan 12.

MR Imaging in Diagnosis of Pelvic Floor Descent: Supine versus Sitting Position

Francesca Iacobellis  1 , Antonio Brillantino  2 , Adolfo Renzi  2 , Luigi Monaco  3 , Nicola Serra  1 , Beatrice Feragalli  4 , Aniello Iacomino  1 , Luca Brunese  5 , Salvatore Cappabianca  1
Affiliations

MR Imaging in Diagnosis of Pelvic Floor Descent: Supine versus Sitting Position

Francesca Iacobellis et al. Gastroenterol Res Pract. 2016.

Abstract

Introduction. Functional disorders of the pelvic floor represent have a significant impact on the quality of life. The advent of open-configuration systems allowed for the evaluation of defecation with MR imaging in sitting position. The purpose of the present study is to compare the results of static and dynamic pelvic MR performed in supine position versus sitting position, using a new MR prototype machine, in the diagnosis of pelvic floor descent. Materials and Methods. Thirty-one patients with pelvic floor disorders were enrolled, and underwent MR Defecography in supine position with 1.5 T closed magnet (MAGNETOM Symphony, Siemens, Germany) and in sitting position with a 0.25-Tesla open magnet system (G-Scan ESAOTE, Italy). Results. In rest and squeezing phases, positions of bladder, vagina, and ARJ were significantly different when the patient was imaged in supine versus sitting position. In the defecation phase, a significant difference for the bladder and vagina position was detected between the two exams whereas a significant difference for the ARJ was not found. A statistically significant difference exists when the pelvic floor descent is evaluated in sitting versus supine position. Conclusion. Our results show that MR Defecography in sitting position may represent a useful tool to correctly diagnose and grade the pelvic organ descent.

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Figures

Figure 1
Figure 1
“Pelvic scan” prototype.
Figure 2
Figure 2
MR Defecography. Rest phase in sitting (a) and supine (b) position. Evacuation phase in sitting (c) and supine (d) position. The pathological fixed descent was detected only in sitting position in rest phase (a). In evacuation phase, a cystocele became evident (d), whereas the maximal descent of the ARJ is similar in both sitting and supine position (c, d). BB: bladder base; VF: vaginal fornix; ARJ: anorectal junction.
Figure 3
Figure 3
MR Defecography. Rest phase in sitting (a) and supine (b) position. Evacuation phase in sitting (c) and supine (d) position. The pathological fixed descent was detected only in sitting position in rest phase (a). In evacuation phase, a cystocele and a vaginal vault prolapse became evident (c), and the MR examination in supine position overestimates the dynamic descent, nonpathological in (a) and (c) and pathological in (b) and (d). BB: bladder base; VV: vaginal vault; ARJ: anorectal junction.
Figure 4
Figure 4
MR Defecography. Rest phase in sitting (a) and supine (b) position. Evacuation phase in sitting (c) and supine (d) position. The pathological fixed descent was detected only in sitting position in rest phase (a). In evacuation phase, the MR examination in supine position overestimates the dynamic descent; the rectocele is seen only in sitting position. BB: bladder base; VF: vaginal fornix; ARJ: anorectal junction.
Figure 5
Figure 5
ANOVA box plot for bladder (a) and ARJ (b) measures of all the patients.
Figure 6
Figure 6
ANOVA box plot for bladder (a), vagina (b), and ARJ (c) measures of the female subgroup.
Figure 7
Figure 7
Strong linear correlation for bladder measures in all phases between sitting and supine positions, for all patients.
Figure 8
Figure 8
Linear correlation graphs of bladder and ARJ measures on all patients and of bladder, vagina, and ARJ measures on FG in defecation phase between sitting and supine positions.
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