Assessment and grading of pelvic organ prolapse by use of dynamic magneticresonance imaging

OBJECTIVE: Our purpose was to assess and compare a new technique of grading pelvic organ prolapse by using dynamic magnetic resonance imaging with the clinical staging proposed by the International Continence Society. STUDY DESIGN: In a cross-sectional study, 20 patients with pelvic organ pro lapse underwent dynamic magnetic resonance imaging. Clinical staging (accor ding to the International Continence Society) was compared with staging by magnetic resonance imaging. A new reference line, the midpubic line, was dr awn on the magnetic resonance image to correspond to the hymenal ring marke r used in the clinical staging. The levator-vaginal angle and the area of t he genital hiatus were measured to indicate vaginal supports. Ten nulliparo us, symptom-free women were studied as control subjects. RESULTS: The proposed staging by magnetic resonance imaging showed good cor relation with the clinical staging (K = 0.61). Magnetic resonance Imaging i mproved clinical assessment by its ability to measure the actual pelvic org an descent and to delineate prolapse of the pouch of Douglas accurately. Th e midpubic line was a useful reference line for grading prolapse on magneti c resonance imaging. The levator-vaginal angle and the area of the genital hiatus are useful in assessing vaginal support at different anatomic levels . CONCLUSIONS: This new method of grading by magnetic resonance imaging uses the same landmarks as the clinical grading, and this uniformity of approach allows an objective assessment of the results of surgical correction of pe lvic organ prolapse.