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Lookup NU author(s): Dr Helen Parker
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© 2018 Springer Science+Business Media, LLC, part of Springer Nature Objectives: To assess the extents of pelvic floor descent both during the maximal straining phase and the defecation phase in healthy volunteers and in patients with pelvic floor disorders, studied with MR defecography (MRD), and to define specific threshold values for pelvic floor descent during the defecation phase. Material and methods: Twenty-two patients (mean age 51 ± 19.4) with obstructed defecation and 20 healthy volunteers (mean age 33.4 ± 11.5) underwent 3.0T MRD in supine position using midsagittal T2-weighted images. Two radiologists performed measurements in reference to PCL-lines in straining and during defecation. In order to identify cutoff values of pelvic floor measurements for diagnosis of pathologic pelvic floor descent [anterior, middle, and posterior compartments (AC, MC, PC)], receiver-operating characteristic (ROC) curves were plotted. Results: Pelvic floor descent of all three compartments was significantly larger during defecation than at straining in patients and healthy volunteers (p < 0.002). When grading pelvic floor descent in the straining phase, only two healthy volunteers showed moderate PC descent (10%), which is considered pathologic. However, when applying the grading system during defecation, PC descent was overestimated with 50% of the healthy volunteers (10 of 20) showing moderate PC descent. The AUC for PC measurements during defecation was 0.77 (p = 0.003) and suggests a cutoff value of 45 mm below the PCL to identify patients with pathologic PC descent. With the adapted cutoff, only 15% of healthy volunteers show pathologic PC descent during defecation. Conclusion: MRD measurements during straining and defecation can be used to differentiate patients with pelvic floor dysfunction from healthy volunteers. However, different cutoff values should be used during straining and during defecation to define normal or pathologic PC descent.
Author(s): Schawkat K, Heinrich H, Parker HL, Barth BK, Mathew RP, Weishaupt D, Fox M, Reiner CS
Publication type: Article
Publication status: Published
Journal: Abdominal Radiology
Year: 2018
Volume: 43
Issue: 12
Pages: 3233-3240
Print publication date: 01/12/2018
Online publication date: 01/06/2018
Acceptance date: 02/04/2018
ISSN (print): 2366-004X
ISSN (electronic): 2366-0058
Publisher: Springer New York LLC
URL: https://doi.org/10.1007/s00261-018-1652-7
DOI: 10.1007/s00261-018-1652-7
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