Magnetic Resonance

European Radiology

, Volume 21, Issue 6, pp 1243-1249

Open Access This content is freely available online to anyone, anywhere at any time.

Feasibility of diffusion tensor imaging (DTI) with fibre tractography of the normal female pelvic floor

  • F. M. ZijtaAffiliated withDepartment of Radiology, Academic Medical Center, University of AmsterdamDepartment of Radiology, Onze Lieve Vrouwe Gasthuis Email author 
  • , M. FroelingAffiliated withDepartment of Radiology, Academic Medical Center, University of AmsterdamBiomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology
  • , M. P. van der PaardtAffiliated withDepartment of Radiology, Academic Medical Center, University of Amsterdam
  • , M. M. E. LakemanAffiliated withDepartment of Gynaecology, Academic Medical Center, University of Amsterdam
  • , S. BipatAffiliated withDepartment of Radiology, Academic Medical Center, University of Amsterdam
  • , A. D. Montauban van SwijndregtAffiliated withDepartment of Radiology, Onze Lieve Vrouwe Gasthuis
  • , G. J. StrijkersAffiliated withBiomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology
  • , A. J. NederveenAffiliated withDepartment of Radiology, Academic Medical Center, University of Amsterdam
  • , J. StokerAffiliated withDepartment of Radiology, Academic Medical Center, University of Amsterdam

Abstract

Objectives

To prospectively determine the feasibility of diffusion tensor imaging (DTI) with fibre tractography as a tool for the three-dimensional (3D) visualisation of normal pelvic floor anatomy.

Methods

Five young female nulliparous subjects (mean age 28 ± 3 years) underwent DTI at 3.0T. Two-dimensional diffusion-weighted axial spin-echo echo-planar (SP-EPI) pulse sequence of the pelvic floor was performed, with additional T2-TSE multiplanar sequences for anatomical reference. Fibre tractography for visualisation of predefined pelvic floor and pelvic wall muscles was performed offline by two observers, applying a consensus method. Three eigenvalues (λ1, λ2, λ3), fractional anisotropy (FA) and mean diffusivity (MD) were calculated from the fibre trajectories.

Results

In all subjects fibre tractography resulted in a satisfactory anatomical representation of the pubovisceral muscle, perineal body, anal - and urethral sphincter complex and internal obturator muscle. Mean FA values ranged from 0.23 ± 0.02 to 0.30 ± 0.04, MD values from 1.30 ± 0.08 to 1.73 ± 0.12 × 10³ mm²/s. Muscular structures in the superficial layer of the pelvic floor could not be satisfactorily identified.

Conclusions

This study demonstrates the feasibility of visualising the complex three-dimensional pelvic floor architecture using 3T-DTI with fibre tractography. DTI of the deep female pelvic floor may provide new insights into pelvic floor disorders.

Keywords

Magnetic Resonance Imaging (MRI) Diffusion Tensor Imaging (DTI) Pelvic floor Fibre tractography Anatomy