DIAGNOSIS:
a.
MRI Defecography
b. Cystocele, uterine prolapse and rectal descent
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Fig. 4: Dynamic, sagittal True-FISP image taken during defecation. There is descent of the anterior compartment-cystocoele (short thick arrow), mid pelvic compartment- uterine prolapse (long thin arrow) and posterior compartment- rectal descent (star), in relation to the pubo-coccygeal “PC” line (dotted line) |
Fig. 5: Dynamic, coronal True-FISP image, taken during defecation. The right ovary (short thick arrow) with multiple small follicles, is seen to prolapse with the rest of the pelvic floor. The left ovary is seen within the pelvic cavity (star). |
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Fig. 6: Dynamic, Sagittal True-FISP image, taken at the end of defecation. There is infolding of the rectal wall (white star) seen as crumpled hyperintensity filling the rectal lumen and widening the anal canal (black star).
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Fig. 7:
Dynamic, sagittal True-FISP image, taken at the end of defecation (empty rectal lumen devoid of hyperintense sono gel). A balloon like hyperintense structure – peritoneocoele (white star), is seen inferiorly, behind the prolapsed uterus (short thick arrow) and anterior to the anal canal (long thin arrow). Widening of the recto-uterine space is also seen at this stage (black star). |
In this patient, there is severe, tri-compartment, pelvic floor descent during defecation with cystocele, uterine prolapse and rectal descent (Fig 4). The coronal section (Fig 5) shows prolapse of the right ovary. There is external rectal prolapse (Fig 6) and peritoneocele - prolapse of the peritoneal fat (Fig 7).
MR defecography is the dynamic MRI evaluation of the pelvic floor performed for indications like pelvic organ prolapse, urinary incontinence and obstructive defecation syndrome. It is superior to fluoroscopic studies (conventional defecography) as, in addition to being less cumbersome and free of ionizing radiation, it allows simultaneously evaluation of the muscular and ligamentous support structures of the pelvic floor along with identification of other incidental anomalies. In MRI defecography, the location of the pelvic organs is assessed in relation to a reference line, the pubo-coccygeal or the “PC line” and the descent is graded as mild, moderate and severe, depending on the distance measured from the PC line. Each compartment is staged separately.
References:
- Colaiacomo et al. Dynamic MR Imaging of the Pelvic Floor: A Pictorial Review; RadioGraphics 2009; 10.1148
- Dynamic Magnetic Resonance Defecography; chapter 23 in “Imaging Atlas of the Pelvic Floor and Anorectal Diseases” ; A Brandao; Springer-Verlag Italia 2008; Pages 219-236
PubMed search results for MRI Defecography, Cystocele, uterine prolapse and rectal descent
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