Muscle defects seen on MRI correlate with symptoms of POP or histories of prior vaginal reconstructive surgery or episiotomy [40]. Secondary findings of vaginal support defects such as displaced lateral and apical vaginal wall are also seen on MRI [42,43]. Imaging during dynamic maneuvers provides functional assessment of the pelvic floor. Dynamic pelvic floor MRI can detect POP in multiple compartments and may be most beneficial for diagnosis of enteroceles [44]. Although interobserver agreement for anterior and middle compartment prolapse is good to excellent [45,46], studies have shown variability in terms of correlation of findings on dynamic pelvic floor MRI with that on physical examination [45]. Furthermore, the detection rate of POP has been reported to be lower on MRI scans without rectal contrast than with rectal contrast [15]. Multiple studies have shown that dynamic pelvic floor MRI with straining rather than defecation demonstrates lower prevalence of prolapse in multiple compartments [12,15,26-29]. Thus, although it may be used for assessment of POP, dynamic pelvic floor MRI during straining (without defecation) is inferior to MR defecography for evaluation of a protruding or bulging vaginal mass or clinically suspected POP and is not considered the initial imaging examination of choice. MRI Pelvis To our knowledge, there is no relevant literature regarding the use of MRI pelvis without defecation or straining for functional assessment of a protruding or bulging vaginal mass or clinically suspected POP. MRI pelvis either without or with IV contrast 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 Pelvic Floor Dysfunction in Females the urethral ligaments [37].
Pelvic Floor Dysfunction in Females. Muscle defects seen on MRI correlate with symptoms of POP or histories of prior vaginal reconstructive surgery or episiotomy [40]. Secondary findings of vaginal support defects such as displaced lateral and apical vaginal wall are also seen on MRI [42,43]. Imaging during dynamic maneuvers provides functional assessment of the pelvic floor. Dynamic pelvic floor MRI can detect POP in multiple compartments and may be most beneficial for diagnosis of enteroceles [44]. Although interobserver agreement for anterior and middle compartment prolapse is good to excellent [45,46], studies have shown variability in terms of correlation of findings on dynamic pelvic floor MRI with that on physical examination [45]. Furthermore, the detection rate of POP has been reported to be lower on MRI scans without rectal contrast than with rectal contrast [15]. Multiple studies have shown that dynamic pelvic floor MRI with straining rather than defecation demonstrates lower prevalence of prolapse in multiple compartments [12,15,26-29]. Thus, although it may be used for assessment of POP, dynamic pelvic floor MRI during straining (without defecation) is inferior to MR defecography for evaluation of a protruding or bulging vaginal mass or clinically suspected POP and is not considered the initial imaging examination of choice. MRI Pelvis To our knowledge, there is no relevant literature regarding the use of MRI pelvis without defecation or straining for functional assessment of a protruding or bulging vaginal mass or clinically suspected POP. MRI pelvis either without or with IV contrast 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 Pelvic Floor Dysfunction in Females the urethral ligaments [37].