[23][23]MR defecography agrees with physical examination in 79% of cases of clinically significant posterior compartment prolapse and, in one study, detected 45% of cases of enteroceles seen on physical examination; however, physical examination only demonstrated 30% of enteroceles seen on MR defecography and also misdiagnosed 10% of enteroceles seen as rectoceles. Thus, MR defecography is beneficial in detecting or characterizing enteroceles as cause of posterior vaginal bulge [34]. Cul-de-sac hernias such as enteroceles are best seen at the end of the defecation acquisition upon complete rectal emptying. This may require multiple defecation attempts and/or additional imaging with maximal Valsalva after complete rectal emptying. Additional utility of MR defecography lies in its ability to demonstrate often unsuspected pelvic floor abnormalities in other compartments. Pelvic Floor Dysfunction in Females MRI Pelvis Dynamic Maneuvers without Defecation Use of rectal contrast and imaging during defecation are particularly important when performing MRI for assessment of defecatory dysfunction [89]. Multiple studies have demonstrated the added benefit of MRI with rectal contrast and the defecation phase for assessment of POP compared with dynamic straining MRI without rectal contrast or defecation [15,26-29]. Thus, the utility of MRI pelvis with dynamic maneuvers (dynamic pelvic floor MRI) to demonstrate functional abnormalities or occult multicompartment defects in the setting of defecatory dysfunction is relatively limited when compared with MR defecography. The inherent high soft-tissue contrast resolution of MRI allows for anatomic evaluation by direct visualization of the pelvic organs and pelvic floor muscles and fascia. Pelvic masses that may cause rectal obstruction would be well seen on MRI. Levator muscle defects may be well depicted in patients with fecal incontinence.
Pelvic Floor Dysfunction in Females. [23][23]MR defecography agrees with physical examination in 79% of cases of clinically significant posterior compartment prolapse and, in one study, detected 45% of cases of enteroceles seen on physical examination; however, physical examination only demonstrated 30% of enteroceles seen on MR defecography and also misdiagnosed 10% of enteroceles seen as rectoceles. Thus, MR defecography is beneficial in detecting or characterizing enteroceles as cause of posterior vaginal bulge [34]. Cul-de-sac hernias such as enteroceles are best seen at the end of the defecation acquisition upon complete rectal emptying. This may require multiple defecation attempts and/or additional imaging with maximal Valsalva after complete rectal emptying. Additional utility of MR defecography lies in its ability to demonstrate often unsuspected pelvic floor abnormalities in other compartments. Pelvic Floor Dysfunction in Females MRI Pelvis Dynamic Maneuvers without Defecation Use of rectal contrast and imaging during defecation are particularly important when performing MRI for assessment of defecatory dysfunction [89]. Multiple studies have demonstrated the added benefit of MRI with rectal contrast and the defecation phase for assessment of POP compared with dynamic straining MRI without rectal contrast or defecation [15,26-29]. Thus, the utility of MRI pelvis with dynamic maneuvers (dynamic pelvic floor MRI) to demonstrate functional abnormalities or occult multicompartment defects in the setting of defecatory dysfunction is relatively limited when compared with MR defecography. The inherent high soft-tissue contrast resolution of MRI allows for anatomic evaluation by direct visualization of the pelvic organs and pelvic floor muscles and fascia. Pelvic masses that may cause rectal obstruction would be well seen on MRI. Levator muscle defects may be well depicted in patients with fecal incontinence.