DYNAMIC MR COLPOCYSTORECTOGRAPHY ASSESSING PELVIC-FLOOR DESCENT

Magnetic resonance colpocystorectography (MR-CCRG) is presented in the evaluation of patients with pelvic-floor disorders. Five healthy volu nteers and 44 female patients with isolated or combined visceral desce nt underwent dynamic MRI and dynamic fluoroscopy (DF). MR-CCRG was per formed with the patient in a supine position using a True FISP sequenc e (1 image/1.2 s; in-plane resolution 1.02 mm) during pelvic floor con traction, relaxation, and straining maneuvers. Relevant organs, such a s urethra, bladder, vagina, and rectum, were opacified by using a sali ne solution, Magnevist (Schering AG, Berlin, Germany), and sonography gel, respectively. The clinical evaluation and the intraoperative resu lts (30 cases) were used as reference. MR-CCRG and DF were non-diagnos tic in 3 cases each. Most patients had a combined type of visceral pro lapse, the most frequent combination being a vaginal vault prolapse an d a cystocele. The points of reference were sufficiently outlined by D F and MR-CCRG. In comparison with the clinical and intraoperative resu lts, MR-CCRG proved to be especially beneficial in the diagnosis of di fferent types of enteroceles including a uterovaginal prolapse. MR-CCR G showed an equal or higher sensitivity and specificity for all indivi dual sites when compared with DF. Also, predominant herniation obscuri ng other concomitant prolapse could be verified in 8 cases. MR-CCRG is superior to DF and accurately depicts pelvic-floor descent and prolap se in women. The possible of dynamic presentation (see enclosed CD-ROM ) allows for a better understanding of the organ movements within a gi ven topographic reference setting.