MAGNETIC-RESONANCE-IMAGING OF PELVIC FLOOR RELAXATION - DYNAMIC ANALYSIS AND EVALUATION OF PATIENTS BEFORE AND AFTER SURGICAL REPAIR

Objective: To evaluate structures involved in pelvic support using con ventional and snapshot magnetic resonance imaging (MRI). Methods: We u sed conventional spin-echo MRI and dynamic snapshot GRASS MRI at vario us levels of the Valsalva maneuver to describe and quantitate the anat omy of pelvic floor relaxation and to assess anatomical changes produc ed by surgical repair. Ten female volunteers were evaluated to define normal anatomy and reference measurements. Five women with pelvic floo r relaxation were evaluated before and after surgical repair. Results: Static and dynamic MRI were more sensitive than clinical pelvic exami nation in assessing and grading pelvic floor relaxation. Quantitative results showed widening of the levator hiatus and more vertical lie of the levator plate postoperatively. Descent of the pelvic organs on ma ximal straining postoperatively was the same as that in normal volunte ers. The posterior urethrovesical angle on MRI was more than 110-degre es in 14 of 15 continent subjects. Conclusions: Magnetic resonance ima ging may be valuable in analyzing and assessing pelvic floor relaxatio n and in understanding anatomical changes occurring before and after s urgical repair. The increased sensitivity of MRI in grading prolapse m ay make it useful in evaluating women with symptoms of pelvic floor re laxation but who have negative findings on clinical examination.