MRI IN Pelvic Floor Disorders

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MRI INPelvic Floor Disorders

• MAHYAR GHAFOORI M.D.
• Associate Professor of Radiology

Tehran University Of Medical Sciences
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Pelvic floor in Women

• Anterior Compartment Bladder Urethra
• Middle Compartment Uterus Vagina
• Posterior Compartment Anorectal

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Normal Anatomy
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Reference Lines

• Pubococcygeal line (PCL)
• From the inferior border of pubic symphysis to
  the last coccygeal joint.
• Level of Pelvic Floor
• H line Max. 5 cm
• From inferior border of pubic symphysis to the
  posterior wall of the rectum at the level of
  anorectal junction.
• AP Width of Levator Hiatus
• M line Max. 2 cm
• Perpendicularly from PCL to the most posterior
  aspect of H line.
• Vertical descent of the levator hiatus

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Rest
Straining
Normal
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Rest
Straining
71 Y/O F Prolapse Fecal Incontinence
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Prolapse Severity Grading
Prolapse of an organ below the PCL 3 cm or less
Mild Between 3 and 6 cm
Moderate More than 6 cm Severe
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Anorectal Angle

• Rest 108 - 127
• Squeezing Close
• Defecation Open

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Puborectalis Muscle
Rest
Squeezing
Straining
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Anterior Compartment
Cystocele Urethral Hypermobility
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Rest
Strain
33mm 0
18mm 65
48 Y/O Stress urinary incontinence frequency
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56 Y/O F Stress urinary incontinence, feeling of
incomplete bladder voiding, ODS
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Middle Compartment
Uterine or Vaginal Vault Prolapse
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Rest
Straining
Defecation
41 Y/O F Severe uterine prolapse
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Rest
Defecation
72 Y/O F Prolapse after Hysterectomy
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Posterior Compartment
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Anterior Rectocele
45 Y/O F history of obstructed defecation
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Posterior Rectocele
During Defecation
41 Y/O F with ODS
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Rectocele
During Defecation
Intrarectal Residue
65 Y/O F History of incomplete evacuation
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Intrarectal Invagination
57 Y/O F Feeling of incomplete evacuation
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Extraanal Invagination (Rectal Prolapse)
Rest
Progressive Straining
63 Y/O F Fecal Incontinence, Hx of Hysterectomy
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Enterocele
Early Defecation
Late Defecation
64 Y/O F Prolapse after Hysterectomy
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3 Compartment Prolapse
Complete Defecation
During Defecation
68 Y/O F Perineal descent, ODS
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3 Compartment Prolapse
Rest
Squeezing
Defecation
62 Y/O F 3 Compartment Descent
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Progressive Straining
65 Y/O F ODS, Hx of Hysterectomy
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Spastic Pelvic Floor Syndrome(Pelvic Floor
Uncoordination, Anismus)
Functional abnormality. Involuntary,
inappropriate paradoxical contraction of
striated pelvic floor musculature evacuation
failure Constipation. Paradoxical contraction
of puborectalis muscle. Puborectalis muscle is
hypertrophic makes an impression on posterior
rectal wall during defecation. Etiology is
unclear (Abnormal muscle activity, psychologic,
cognitive) Anorectal Manometry Increased
pressure at rest during defecation. Pathologic
signals at electromyography.
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Spastic Pelvic Floor Syndrome
Rest
Strain
51 Y/O M ODS
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Progressive Straining
Rest
68 Y/O F Excessive straining incomplete
evacuation
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The End
Mahyar Ghafoori M.D.