Urogenital

European Radiology

, Volume 22, Issue 12, pp 2806-2813

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

Evaluation of the female pelvic floor in pelvic organ prolapse using 3.0-Tesla diffusion tensor imaging and fibre tractography

  • F. M. ZijtaAffiliated withDepartment of Radiology, Academic Medical Centre, University of AmsterdamAmsterdam and Department of Radiology, Onze Lieve Vrouwe GasthuisDepartment of Radiology, Academic Medical Center Email author 
  • , M. M. E. LakemanAffiliated withAmsterdam and Department of Gynaecology, Academic Medical Centre, University of Amsterdam the Netherlands and Biomedical NMR
  • , M. FroelingAffiliated withDepartment of Radiology, Academic Medical Centre, University of AmsterdamDepartment of Biomedical Engineering, Eindhoven University of Technology
  • , M. P. van der PaardtAffiliated withDepartment of Radiology, Academic Medical Centre, University of Amsterdam
  • , C. S. V. BorstlapAffiliated withDepartment of Radiology, Academic Medical Centre, University of Amsterdam
  • , S. BipatAffiliated withDepartment of Radiology, Academic Medical Centre, University of Amsterdam
  • , A. D. Montauban van SwijndregtAffiliated withAmsterdam and Department of Radiology, Onze Lieve Vrouwe Gasthuis
  • , G. J. StrijkersAffiliated withDepartment of Biomedical Engineering, Eindhoven University of Technology
  • , J. P. RooversAffiliated withAmsterdam and Department of Gynaecology, Academic Medical Centre, University of Amsterdam the Netherlands and Biomedical NMR
    • , A. J. NederveenAffiliated withDepartment of Radiology, Academic Medical Centre, University of Amsterdam
    • , J. StokerAffiliated withDepartment of Radiology, Academic Medical Centre, University of Amsterdam

Abstract

Objectives

To prospectively explore the clinical application of diffusion tensor imaging (DTI) and fibre tractography in evaluating the pelvic floor.

Methods

Ten patients with pelvic organ prolapse, ten with pelvic floor symptoms and ten asymptomatic women were included. A two-dimensional (2D) spin-echo (SE) echo-planar imaging (EPI) sequence of the pelvic floor was acquired. Offline fibre tractography and morphological analysis of pelvic magnetic resonance imaging (MRI) were performed. Inter-rater agreement for quality assessment of fibre tracking results was evaluated using weighted kappa (κ). From agreed tracking results, eigen values (λ1, λ2, λ3), mean diffusivity (MD) and fractional anisotropy (FA) were calculated. MD and FA values were compared using ANOVA. Inter-rater reliability of DTI parameters was interpreted using the intra-class correlation coefficient (ICC).

Results

Substantial inter-rater agreement was found (κ = 0.71 [95% CI 0.63–0.78]). Four anatomical structures were reliably identified. Substantial inter-rater agreement was found for MD and FA (ICC 0.60–0.91). No significant differences between groups were observed for anal sphincter, perineal body and puboperineal muscle. A significant difference in FA was found for internal obturator muscle between the prolapse group and the asymptomatic group (0.27 ± 0.05 vs 0.22 ± 0.03; P = 0.015).

Conclusion

DTI with fibre tractography permits identification of part of the clinically relevant pelvic structures. Overall, no significant differences in DTI parameters were found between groups.

Key Points

Diffusion tensor MRI offers new insights into female pelvic floor problems.

DTI allows 3D visualisation and quantification of female pelvic floor anatomy.

DTI parameters from pelvic floor structures can be reliably determined.

No significant differences in DTI parameters between groups with/without prolapse.

Keywords

Magnetic resonance imaging (MRI) Diffusion tensor imaging (DTI) Pelvic floor disorders Fibre tractography Pelvic floor