Pelvic floor descent in females: Comparative study of colpocystodefecography and dynamic fast MR imaging

The purpose of this study was to compare fast dynamic magnetic resonance im aging (MRI) with colpocystodefecography (CCD) in the evaluation of pelvic f loor descent in women. Thirty-five women with clinical evidence of pelvic f loor descent were studied. A fast single-shot MR sequence was performed in the supine position during pelvic floor relaxation and during maximal pelvi c strain, On the same day, a dynamic CCD was performed with the patient sea ted on a stool-chair, The degree of descent of the bladder, vagina, and ano rectal junction was evaluated as the vertical distance between the pubococc ygeal line and the bladder base, the vaginal vault, and the anorectal junct ion, respectively, A bulge of more than 3 cm measured as the distance betwe en the extended line of the anterior border of the anal canal and the tip o f the rectocele was interpreted as a rectocele, MRI was compared with CCD d uring maximal pelvic strain (CCD I) and during voiding and defecation (CCD II). CCD was considered as the gold standard. Compared with clinical examin ation, CCD I showed a larger number of involved compartments, except for th e middle compartment, CCD II was superior to clinical examination in all ca ses, In comparison with CCD I and especially CCD II, MRI had a lower sensit ivity, especially for the anterior and middle compartment, Even four entero celes seen on CCD II were not detected by MRI, When CCD I and CCD II were c ompared, a cystocele, a vaginal vault prolapse, an enterocele, and a rectoc ele were more readily seen on CCD II than with CCD I. When compared with CC D, supine dynamic MRI is unreliable, especially in the anterior and middle compartment, Even in the detection of enteroceles CCD was superior to MRI, In general, the best results with MRI can be expected for evaluation of the rectum. (C) 1999 Wiley-Liss, Inc.