Although there are no studies evaluating the utility of gadolinium IV contrast after surgical repair in the pelvic floor, certain complications such as collections or fistula are better depicted after contrast, as is the case in other parts of the body. Dynamic pelvic floor MRI is generally performed without gadolinium IV contrast, which may be limited compared with MRI pelvis with IV contrast for this indication. Furthermore, functional evaluation with dynamic maneuvers would only be indicated if there is concern for recurrent prolapse, urinary incontinence, or defecatory dysfunction MRI Pelvis MRI of the pelvis with gadolinium IV contrast is often used as an initial test for patients with subacute or chronic complications after pelvic floor repair. The inherent high soft-tissue contrast resolution of MRI allows for anatomic evaluation of the pelvic organs and structural changes after surgery [37,40,108]. In addition to changes in native anatomy, MRI depicts implanted synthetic material including urethral bulking agents, midurethral slings, and different types of vaginal mesh and their complications, although scar tissue may appear similar to sling and mesh components and can confound evaluation [107]. MRI can depict volume and configuration of urethral bulking agent; however, it may not be predictive of clinical outcome [109]. MRI allows for evaluation of urethral slings in the retropubic space better than US, whereas US allows for evaluation in the sub/peri-urethral space [110]. Components of routinely available polypropylene vaginal mesh can typically be seen on T2-weighted MRI. MRI can also assess the integrity of sacrocolpopexy mesh and associated complications such as presacral hematomas, bowel or bladder injury, peritoneal inclusion cyst formation, mesh infection, or discitis/osteomyelitis at the sacral promontory [100,111].
Pelvic Floor Dysfunction in Females. Although there are no studies evaluating the utility of gadolinium IV contrast after surgical repair in the pelvic floor, certain complications such as collections or fistula are better depicted after contrast, as is the case in other parts of the body. Dynamic pelvic floor MRI is generally performed without gadolinium IV contrast, which may be limited compared with MRI pelvis with IV contrast for this indication. Furthermore, functional evaluation with dynamic maneuvers would only be indicated if there is concern for recurrent prolapse, urinary incontinence, or defecatory dysfunction MRI Pelvis MRI of the pelvis with gadolinium IV contrast is often used as an initial test for patients with subacute or chronic complications after pelvic floor repair. The inherent high soft-tissue contrast resolution of MRI allows for anatomic evaluation of the pelvic organs and structural changes after surgery [37,40,108]. In addition to changes in native anatomy, MRI depicts implanted synthetic material including urethral bulking agents, midurethral slings, and different types of vaginal mesh and their complications, although scar tissue may appear similar to sling and mesh components and can confound evaluation [107]. MRI can depict volume and configuration of urethral bulking agent; however, it may not be predictive of clinical outcome [109]. MRI allows for evaluation of urethral slings in the retropubic space better than US, whereas US allows for evaluation in the sub/peri-urethral space [110]. Components of routinely available polypropylene vaginal mesh can typically be seen on T2-weighted MRI. MRI can also assess the integrity of sacrocolpopexy mesh and associated complications such as presacral hematomas, bowel or bladder injury, peritoneal inclusion cyst formation, mesh infection, or discitis/osteomyelitis at the sacral promontory [100,111].