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Dynamische Magnetresonanztomographie des Beckenbodens: Klinische Anwendung

Dynamic magnetic resonance imaging of the pelvic floor: clinical application

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Zusammenfassung

Hintergrund

Die dynamische Magnetresonanztomographie (MRT) des Beckenbodens hat sich als maßgebliche Bildgebung bei komplexer Beckenbodendysfunktion etabliert. Die Analyse und klinische Interpretation sind aufgrund der Vielzahl möglicher, simultan erfasster Befunde und der komplexen Anatomie herausfordernd.

Ziel der Arbeit

Die wichtigsten Aspekte (Anatomie des Beckenbodens, 3‑Kompartimente-Modell, morphologische und funktionelle Analyse, Befundbericht) zur erfolgreichen klinischen Anwendung der dynamischen Beckenboden-MRT werden dargestellt.

Material und Methoden

Recherche und Zusammenfassung der wissenschaftlichen Literatur zur dynamischen Beckenboden-MRT unter besonderer Berücksichtigung der Expertenempfehlungen der ESUR/ESGAR (European Society of Urogenital Radiology/European Society of Gastrointestinal and Abdominal Radiology) von 2016.

Ergebnisse

Der Levator-ani-Komplex, der urethrale Stützapparat und die endopelvine Faszie stellen die zentralen Bestandteile des Beckenbodens dar. Diese werden bezüglich typischer Strukturveränderungen in den statischen Sequenzen zunächst morphologisch evaluiert. Im 3‑Kompartimente-Modell folgt die funktionelle Analyse der dynamischen Sequenzen mit Bestimmung der Beckenorganmobilität und des Beckenorganprolapses (zur pubokokzygealen Linie), des anorektalen Winkels sowie der Beckenbodenrelaxation (durch H‑ und M‑Linie) unter Belastung. Zystozelen, Enterozelen, Peritoneozelen, Rektozelen, uterovaginaler und anorektaler Deszensus werden quantifiziert und graduiert sowie assoziierte Pathologien (hypermobile Urethra, Intussuszeption, dyssynergische Defäkation) evaluiert. Die strukturierte Befunddokumentation ist ratsam.

Diskussion

Die umfassende qualitative und quantitative Analyse der Befunde in der dynamischen Beckenboden-MRT kann gegenüber anderen Bildgebungsmodalitäten therapierelevante Zusatzinformationen liefern und somit die (interdisziplinäre) Behandlung der Beckenbodendysfunktion verbessern.

Abstract

Background

Dynamic magnetic resonance imaging (MRI) of the pelvic floor plays a key role in imaging complex pelvic floor dysfunction. The simultaneous detection of multiple findings in a complex anatomic setting renders correct analysis and clinical interpretation challenging.

Objectives

The most important aspects (anatomy of the pelvic floor, three compartment model, morphological and functional analysis, reporting) for a successful clinical use of dynamic MRI of the pelvic floor are summarized.

Materials and methods

Review of the scientific literature on dynamic pelvic MR imaging with special consideration of the joint recommendations provided by the expert panel of ESUR/ESGAR in 2016.

Results

The pelvic floor is a complex anatomic structure, mainly formed by the levator ani muscle, the urethral support system and the endopelvic fascia. Firstly, morphological changes of these structures are analysed on the static sequences. Secondly, the functional analysis using the three compartment model is performed on the dynamic sequences during squeezing, straining and defecation. Pelvic organ mobility, pelvic organ prolapse, the anorectal angle and pelvic floor relaxation are measured and graded. The diagnosis of cystoceles, enteroceles, rectoceles, the uterovaginal as well as anorectal decent, intussusceptions and dyssynergic defecation should be reported using a structured report form.

Conclusions

A comprehensive analysis of all morphological and functional findings during dynamic MRI of the pelvic floor can provide information missed by other imaging modalities and hence alter therapeutic strategies.

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Authors and Affiliations

  1. Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland

    C. Kämpfer & C. C. Pieper

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  1. C. Kämpfer
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Correspondence to C. Kämpfer.

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C. Kämpfer und C.C. Pieper geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Kämpfer, C., Pieper, C.C. Dynamische Magnetresonanztomographie des Beckenbodens: Klinische Anwendung. Radiologie 63, 799–807 (2023). https://doi.org/10.1007/s00117-023-01223-7

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