MR defecography detects 45% of enteroceles seen on physical examination; however, physical examination only demonstrates 30% of enteroceles seen on MR defecography and misdiagnoses of 10% for enteroceles as rectoceles. Thus MR defecography is beneficial in detecting or differentiating cases of enteroceles in apical or posterior compartment prolapse [34]. Additional utility of MR defecography lies in its ability to demonstrate associated pelvic floor abnormalities in multiple compartments in addition to the expected clinical diagnoses [35,36]. Finally, the static high-resolution T2-weighted images performed as part of a routine MR defecography may be used for anatomic evaluation. The inherent high soft-tissue contrast resolution of MRI allows for assessment of the pelvic organs including the bladder and urethra as well as the urethral ligaments [37]. Routine T2-weighted images acquired at rest have utility in detecting and quantifying levator muscle defects in patients with prolapse [38] with high interobserver reliability [39]. Muscle defects seen on MRI correlate with symptoms of POP or histories of prior vaginal reconstructive surgery or episiotomy [40]. Muscle thickness is measured reliably on MRI with external phased array coils [41]. Secondary findings of vaginal support defects such as displaced lateral and apical vaginal wall are also seen on MRI [42,43]. MRI Pelvis Dynamic Maneuvers without Defecation Pelvic floor MRI with dynamic maneuvers (dynamic pelvic floor MRI) is similar to MR defecography; however, rectal gel or IV contrast are not generally administered, and the cine images are obtained during maximal straining or Valsalva rather than during defecation. MRI allows for comprehensive anatomic and functional evaluation of the entire pelvic floor. The inherent high soft-tissue contrast resolution of MRI allows for direct visualization of the pelvic organs and pelvic floor muscles and fascia [37-39].
Pelvic Floor Dysfunction in Females. MR defecography detects 45% of enteroceles seen on physical examination; however, physical examination only demonstrates 30% of enteroceles seen on MR defecography and misdiagnoses of 10% for enteroceles as rectoceles. Thus MR defecography is beneficial in detecting or differentiating cases of enteroceles in apical or posterior compartment prolapse [34]. Additional utility of MR defecography lies in its ability to demonstrate associated pelvic floor abnormalities in multiple compartments in addition to the expected clinical diagnoses [35,36]. Finally, the static high-resolution T2-weighted images performed as part of a routine MR defecography may be used for anatomic evaluation. The inherent high soft-tissue contrast resolution of MRI allows for assessment of the pelvic organs including the bladder and urethra as well as the urethral ligaments [37]. Routine T2-weighted images acquired at rest have utility in detecting and quantifying levator muscle defects in patients with prolapse [38] with high interobserver reliability [39]. Muscle defects seen on MRI correlate with symptoms of POP or histories of prior vaginal reconstructive surgery or episiotomy [40]. Muscle thickness is measured reliably on MRI with external phased array coils [41]. Secondary findings of vaginal support defects such as displaced lateral and apical vaginal wall are also seen on MRI [42,43]. MRI Pelvis Dynamic Maneuvers without Defecation Pelvic floor MRI with dynamic maneuvers (dynamic pelvic floor MRI) is similar to MR defecography; however, rectal gel or IV contrast are not generally administered, and the cine images are obtained during maximal straining or Valsalva rather than during defecation. MRI allows for comprehensive anatomic and functional evaluation of the entire pelvic floor. The inherent high soft-tissue contrast resolution of MRI allows for direct visualization of the pelvic organs and pelvic floor muscles and fascia [37-39].