Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 May 20:6:187-191.
doi: 10.1016/j.ejro.2019.05.002. eCollection 2019.

Dynamic MR of the pelvic floor: Influence of alternative methods to draw the pubococcygeal line (PCL) on the grading of pelvic floor descent

Simona Picchia  1 , Marco Rengo  1 , Davide Bellini  1 , Damiano Caruso  2 , Eliseo Pironti  3 , Roberto Floris  4 , Andrea Laghi  2
Affiliations

Dynamic MR of the pelvic floor: Influence of alternative methods to draw the pubococcygeal line (PCL) on the grading of pelvic floor descent

Simona Picchia et al. Eur J Radiol Open. .

Abstract

Objective: To evaluate the impact of the pubococcygeal line (PCL) position on hiatal descent grading, comparing the method recommended by the official guidelines with the other two most common methods reported in literature.

Methods: Female patients prospectively included performed dynamic-MR (1,5 T) in supine position. Rectum and vagina were filled with ultrasound gel. MR protocol included TSE T2 weighted sequences on axial/sagittal/coronal planes and steady-state sequences (FIESTA) on midsagittal plane during three phases (rest, strain and defecation). On each phase, the posterior point of PCL was traced in the region recommended by the official guidelines (last coccygeal joint or PCLcc) and in the other two regions: coccyx's tip (PCLtip) and sacrococcygeal joint (PCLsc). The resulting grades of pelvic floor descent (according to HMO-System) were compared. Inter-reader and intra-reader agreement were evaluated.

Results: The final population consisted of 60 patients (56yy±10). No significant differences in grading were observed using PCLtip and PCLcc in all phases (p = 0.3016/0.0719/0.0719 during rest/strain/defecation). Using PCLsc, the grading was significantly overestimated compared to PCLcc in all phases (p = 0.0041/0.0001/0.0001 during rest/strain/defecation). Inter-reader and intra-reader agreement were significantly higher using PCLtip (p < 0.05).

Conclusions: PCLtip is a reliable and highly reproducible option to the official PCLcc to correctly grade the pelvic floor descent and could be used when the PCLcc is not clearly visible. The use of PCLsc overestimates the grading compared to the official PCLcc and should not be used to avoid wrong patients' management.

Keywords: Defecography; FIESTA, Fast Imaging Employing Steady-state Acquisition; FOV, field of view; Fecal incontinence; Incontinence; MR, magnetic Resonance; Magnetic resonance; Mcc, M line obtained by PCLcc; Msc, M line obtained by PCLsc; Mtip, M line obtained by PCLtip; PCL, pubococcygeal line; PCLcc, pubococcygeal line posterior point on the last coccygeal joint; PCLsc, pubococcygeal line posterior point on the sacrococcygeal joint; PCLtip, pubococcygeal line posterior point on the tip of the coccyx; PFD, pelvic floor dysfunction; Pelvic floor; Pelvic pain; STARD, Standards for Reporting of Diagnostic Accuracy; TSE, turbo spin echo; Urinary.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Study population. Fow chart detailing the patient selection process.
Fig. 2
Fig. 2
The three different ways to draw the pubococcygeal line (PCL) were shown on the same patient. The posterior point was placed on the sacrococcygeal joint(a), the coccix’s tip(b) and the last coccygeal joint(c).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Carrillo-Izquierdo M.D., Slim M., Hidalgo-Tallon J., Calandre E.P. Pelvic floor dysfunction in women with fibromyalgia and control subjects: Prevalence and impact on overall symptomatology and psychosocial function. Neurourol. Urodyn. 2018;37(8):2702–2709. - PubMed
    1. Kuncharapu I., Majeroni B.A., Johnson D.W. Pelvic organ prolapse. Am. Fam. Phys. 2010;81(9):1111–1117. - PubMed
    1. Alapati S., Jambhekar K. Dynamic magnetic resonance imaging of the pelvic floor. Semin. Ultrasound CT MR. 2017;38(3):188–199. - PubMed
    1. Boyadzhyan L., Raman S.S., Raz S. Role of static and dynamic MR imaging in surgical pelvic floor dysfunction. Radiographics. 2008;28(4):949–967. - PubMed
    1. Comiter C.V., Vasavada S.P., Barbaric Z.L., Gousse A.E., Raz S. Grading pelvic prolapse and pelvic floor relaxation using dynamic magnetic resonance imaging. Urology. 1999;54(3):454–457. - PubMed

LinkOut - more resources