Fatih Mustafa Akisik MD, Presenter: Nothing to Disclose

Temel Tirkes MD, Abstract Co-Author: Nothing to Disclose

Kumaresan Sandrasegaran MD, Abstract Co-Author: Research grant, Siemens AG Consultant, Repligen Corporation

Marc D. Kohli MD, Abstract Co-Author: Nothing to Disclose

Sesh Kasturi MD, Abstract Co-Author: Nothing to Disclose

Douglass Hale MD, Abstract Co-Author: Nothing to Disclose

Alex M. Aisen MD, Abstract Co-Author: Consultant, Repligen Corporation Research grant, Repligen Corporation Consultant, Carestream Health, Inc

John C. Lappas MD, Abstract Co-Author: Nothing to Disclose

To evaluate the value of pelvic organ prolapse before and after surgery with mesh using an unbiased MRI measurement.

This prospective study was done after IRB approval. Pre- and post surgery MRI exams were studied with 3 T MRI scan. Patients were instructed about the voluntary maneuvers which consisted of progressive straining and a contraction of the pelvic floor muscles (squeeze) followed by relaxation. The vagina and rectum were then opacified with 20ml and 200ml respectively, of sonographic transimission gel (Aquasonic 100, Parker Laboratories, Fairfield, NJ) Patients were then asked to perform the rest-squeeze-relax- strain maneuver as previously described as part of the prolapse staging protocol. A dynamic series of images were obtained in the mid-sagittal plane using a true fast imaging in a steady-state free precision sequence.

10 patients were enrolled to the study.  Improvements were seen in all compartments in all of the patients whose condition was studied with MRI.  The mesh appeared to be a dark linear line with a thickness of 2-3 mm. In 7 of 10 patients (70%), the mesh was identified reliably in all 3 compartments. In 1 patient (10%), the mesh was not identified on MRI in any compartment. In 1 patient (10%), the mesh was not identified in the anterior compartment.  In 1 patient (10%) who underwent extraperitoneal colpopexy, the mesh was not identified at the apex. Minimal tissue reaction was seen on postoperative MRIs. Differences between pre and post operative prolapse quantification (POP-Q) mean changes in various POP Q points were as follows: Aa -2.5 (p=0.004), Ba -4.0 (p=0.003), Ap -3.3 (p<0.001), Bp -4.8 (p<0.001), C -8.6 (p<0.001), TVL -0.3 (p=0.496), GH -2.4 (p=0.009) and PB -0.1 (p=0.906). Mean changes in various measurements on MRI are as follows: pubococcegeal line (PCL) 0.0 (p=0.940), H line -0.5 (p=0.170), M line -0.3 (p=0.375), cystocele 2.4 (p=0.050), enterocele 4.6 (0.003), rectocele -1.6 (0.056), apex 4.4 (0.003). The correlations between changes in POP Q and MRI are: Aa and cystocele -0.91 (p,0.001), Ba and cystocele -0.46 (p=0.186), Ap and rectocele 0.63 (p=0.050), Bp and enterocele -0.56 (p=0.096), C and apex -0.63 (p=0.053).

MRI is an useful imaging tool in pre and postoperative evaluation of the pelvic organ prolapse. 

Quantitiave evaluation of pelvic floor surgery and evaluate mesh with dynamic pelvic MR is a reliable method.

Akisik, F, Tirkes, T, Sandrasegaran, K, Kohli, M, Kasturi, S, Hale, D, Aisen, A, Lappas, J, Dynamic MRI for Pre- and Postoperative Assessment of the Pelvic Organ Prolapse.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11034501.html