Utilizing intelligent pelvic floor ultrasonography combined with real-time shear wave elastography for evaluating female pelvic floor functions

Abstract

Background: Given the high prevalence of pelvic floor disorders (PFD) and their association with structural and functional compromise of the levator ani muscle complex, particularly the puborectalis, this study aims to assess pelvic floor functionality by using intelligent pelvic floor ultrasound combined with real-time shear wave elastography (SWE) to evaluate anatomical integrity, mobility, and tissue elasticity.

Methods: Seventy-one women presenting symptoms indicative of PFD were enrolled in this study and constituted the PFD group. In contrast, an equal number of women lacking such symptoms comprised the non-PFD group. Among the latter, 54 cases exhibited normal pelvic function, serving as the normal control group. Subsequently, participants were divided into subsets based on pelvic floor ultrasound findings, distinguishing between those with normal and abnormal two-dimensional (2D) and three-dimensional (3D) imaging results. Various parameters from pelvic floor 2D and 3D ultrasound examinations, along with real-time SWE measurements conducted during rest, contraction, and Valsalva maneuvers, were analyzed.

Results: In the normal control group, there was no significant difference in Young's modulus between the left and right puborectalis muscles (P>0.05), so data were combined for analysis. Among physiological states, Young's modulus followed the pattern: contraction [median (interquartile range): 100.90 (80.66, 119.94) kPa] > Valsalva [64.00 (44.57, 82.90) kPa] > resting [46.23 (30.68, 65.84) kPa], with all comparisons showing statistical significance (P<0.05). No significant difference in puborectalis muscle stiffness was observed between the PFD group and the non-PFD group overall (P>0.05). However, within the PFD group, during the resting state, both the 2D abnormal subgroup (45.51±19.20 kPa) and 3D abnormal subgroup [41.72 (28.57, 57.14) kPa] exhibited significantly lower Young's modulus compared to their respective normal subgroups [2D normal: 61.70±22.74 kPa; 3D normal: 53.50 (38.89, 72.73) kPa; P<0.05]. These differences were not present during contraction or Valsalva (P>0.05). In the non-PFD group, no significant differences in stiffness were found between the 2D/3D abnormal and normal subgroups in any state (P>0.05).

Conclusions: SWE offers a quantitative assessment of the firmness and resilience of the puborectalis muscle, as well as the changes in muscle firmness across distinct pelvic floor states. This analysis furnishes empirical evidence supporting the manifestation of symptoms associated with PFD.

Keywords: Intelligent pelvic floor ultrasound; Young’s modulus; pelvic floor disorders (PFD); real-time shear wave elastography (real-time SWE); ultrasound.