Abstract:
HTML
Purpose: To evaluate female urinary stress incontinence with MRI.
Methods and Materials: 23 female patients with urinary incontinence were evaluated with MRI using a 1.5 superconductive magnet. All patients were previously evaluated using urodynamic procedure and with conventional cystourethrography. We performed both static and dynamic studies with MRI. In the static study the patients had urine-filled bladders and we performed sagittal, coronal and axial TSE T2-weighted scans acquired at the level of the pelvic floor (slice thickness: 3 mm). Then the patients had to empty their bladders and the bladders were filled again with contrast-material-enhanced urine by i.v administration of 20 mg of furosemide followed by i.v. administration of 3/4 of the normal dose of Gd-DTPA. The rectal lumen was inflated with air inserted through a Foley catheter. The patients were asked to perform the Valsalva manoeuvre and a sagittal and coronal FFE T1-weighted scans was acquired. Then the patient was asked to urinate and during micturition T1-weighted spoiled 3D gradient-echo acquisitions on sagittal plane were performed (TR: 5.1 ms; TE: 1.5 ms; flip-angle: 40d; slice thickness: 2 mm; acquisition time: 12 s). The 3D row images were post-processed with MIP algorithms in order to obtain images very similar to voiding cystourethrography.
Results: Static TSE T2-weighted scans allowed a perfect visualization of the different muscular and fascial components of the pelvic floor. In 5 patients we detected an hypotrophy or asymmetry of levator ani muscles. We detected 5 bladder neck prolapses, 8 cystoceles, 4 urethral diverticula, 3 hysteroptosis, 1 elytrocele and 4 rectoceles. We detected with MRI 2 concomitant prolapses in 2 different patients. The sagittal TSE T2-weighted scans perfectly detected the urethral diverticula while sagittal and coronal scans during Valsalva manoeuvre showed pelvic floor dysfunction. Homogeneous opacification of the bladder lumen was constantly obtained. The visualization of the urethra with MIP reconstructed images was considered comparable to that obtained with conventional cystourethrography. The sagittal acquisitions during micturition with the evaluation of the pubo-coccygeal line allowed a perfect study of the anterior prolapses.
Conclusion: In the evaluation of urinary stress incontinence, MRI allows a more accurate and panoramic visualization of the female pelvic organ prolapses when compared with conventional cystourethrography and could be particularly helpful for surgical planning.
Questions about this event email: digirolamomarco@hotmail.com
Di Girolamo MD, M,
Urinary Stress Incontinence in Women: Evaluation with MRI Using Static and Dynamic Tests for the Study of Pelvic Floor and During Micturation. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3104496.html
