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Use of Dynamic MRI of the Pelvic Floor in the Assessment of Anterior Compartment Disorders

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Purpose of Review

Approximately 25% of women in the USA suffer from pelvic floor disorders. Disorders of the anterior compartment of the pelvic floor, in particular, can cause symptoms such as incomplete urinary voiding, urinary incontinence, pelvic organ prolapse, dyspareunia, and pelvic pain, potentially negatively impacting a woman’s quality of life. In some clinical situations, clinical exam alone may be insufficient, especially when patient’s symptoms are in excess of their pelvic exam findings. In many of these patients, dynamic magnetic resonance imaging (dMRI) of the pelvic floor can be a valuable imaging tool allowing for comprehensive assessment of the entire pelvic anatomy and its function.

Recent Findings

Traditionally, evaluation of the anterior compartment has been primarily through clinical examination with occasional use of urodynamic testing and ultrasound. In recent years, dMRI has continued to gain popularity due to its improved imaging quality, reproducibility, and ability to display the entire pelvic floor. Emerging evidence has also shown utility of dMRI in the postoperative setting. In spite of advances, there remains an ongoing discussion in contemporary literature regarding the accuracy of dMRI and its correlation with clinical examination and with patient symptoms.


Dynamic pelvic MRI is a helpful adjunct to physical examination and urodynamic testing, particularly when a patient’s symptoms are in excess of the physical examination findings. Evaluation with dMRI can guide preoperative and postoperative surgical management in many patients, especially in the setting of multicompartmental disorders. This review will summarize relevant pelvic floor anatomy and discuss the clinical application, imaging technique, imaging interpretation, and limitations of dMRI.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Wu JM, Vaughan CP, Goode PS, Redden DT, Burgio KL, Richter HE, et al. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstet Gynecol. 2014;123(1):141–8.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Kaufman HS, Buller JL, Thompson JR, Pannu HK, DeMeester SL, Genadry RR, et al. Dynamic pelvic magnetic resonance imaging and cystocolpoproctography alter surgical management of pelvic floor disorders. Dis Colon Rectum. 2001;44(11):1575–83 discussion 1583-1574.

    Article  CAS  Google Scholar 

  3. Elshazly WG, El Nekady Ael A, Hassan H. Role of dynamic magnetic resonance imaging in management of obstructed defecation case series. Int J Surg. 2010;8(4):274–82.

    Article  PubMed  Google Scholar 

  4. Kamal EM, Abdel Rahman FM. Role of MR imaging in surgical planning and prediction of successful surgical repair of pelvic organ prolapse. Middle East Fertil Soc J. 2013;18(3):196–201.

    Article  Google Scholar 

  5. Boyadzhyan L, Raman SS, Raz S. Role of static and dynamic MR imaging in surgical pelvic floor dysfunction. Radiographics. 2008;28(4):949–67.

    Article  PubMed  Google Scholar 

  6. Hetzer FH, Andreisek G, Tsagari C, Sahrbacher U, Weishaupt D. MR defecography in patients with fecal incontinence: imaging findings and their effect on surgical management. Radiology. 2006;240(2):449–57.

    Article  PubMed  Google Scholar 

  7. DeLancey JO. Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis. Am J Obstet Gynecol. 1994;170(6):1713–20 discussion 1720-1713.

    Article  CAS  Google Scholar 

  8. Khatri G, de Leon AD, Lockhart ME. MR imaging of the pelvic floor. Magn Reson Imaging Clin N Am. 2017;25(3):457–80.

    Article  PubMed  Google Scholar 

  9. Singh K, Reid WM, Berger LA. Assessment and grading of pelvic organ prolapse by use of dynamic magnetic resonance imaging. Am J Obstet Gynecol. 2001;185(1):71–7.

    Article  CAS  PubMed  Google Scholar 

  10. Fauconnier A, Zareski E, Abichedid J, Bader G, Falissard B, Fritel X. Dynamic magnetic resonance imaging for grading pelvic organ prolapse according to the International Continence Society classification: which line should be used? Neurourol Urodyn. 2008;27(3):191–7.

    Article  PubMed  Google Scholar 

  11. Lienemann A, Sprenger D, Janssen U, Grosch E, Pellengahr C, Anthuber C. Assessment of pelvic organ descent by use of functional cine-MRI: which reference line should be used? Neurourol Urodyn. 2004;23(1):33–7.

    Article  PubMed  Google Scholar 

  12. Broekhuis SR, Futterer JJ, Barentsz JO, Vierhout ME, Kluivers KB. A systematic review of clinical studies on dynamic magnetic resonance imaging of pelvic organ prolapse: the use of reference lines and anatomical landmarks. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(6):721–9.

    Article  PubMed  Google Scholar 

  13. DeLancey JO, Kearney R, Chou Q, Speights S, Binno S. The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery. Obstet Gynecol. 2003;101(1):46–53.

    PubMed  PubMed Central  Google Scholar 

  14. Shek KL, Dietz HP. Intrapartum risk factors for levator trauma. BJOG. 2010;117(12):1485–92.

    Article  CAS  PubMed  Google Scholar 

  15. Lockhart ME, Bates GW, Morgan DE, Beasley TM, Richter HE. Dynamic 3T pelvic floor magnetic resonance imaging in women progressing from the nulligravid to the primiparous state. Int Urogynecol J. 2018;29(5):735–44.

    Article  PubMed  Google Scholar 

  16. Morgan DM, Larson K, Lewicky-Gaupp C, Fenner DE, DeLancey JO. Vaginal support as determined by levator ani defect status 6 weeks after primary surgery for pelvic organ prolapse. Int J Gynaecol Obstet. 2011;114(2):141–4.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Clark NA, Brincat CA, Yousuf AA, Delancey JO. Levator defects affect perineal position independently of prolapse status. Am J Obstet Gynecol. 2010;203(6):595–e517–522.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Chamie LP, Ribeiro D, Caiado AHM, Warmbrand G, Serafini PC. Translabial US and dynamic MR imaging of the pelvic floor: normal anatomy and dysfunction. Radiographics. 2018;38(1):287–308.

    Article  PubMed  Google Scholar 

  19. Yang A, Mostwin JL, Rosenshein NB, Zerhouni EA. Pelvic floor descent in women: dynamic evaluation with fast MR imaging and cinematic display. Radiology. 1991;179(1):25–33.

    Article  CAS  PubMed  Google Scholar 

  20. Garcia del Salto L, de Miguel Criado J, Aguilera del Hoyo LF, Gutierrez Velasco L, Fraga Rivas P, Manzano Paradela M, et al. MR imaging-based assessment of the female pelvic floor. Radiographics. 2014;34(5):1417–39.

    Article  PubMed  Google Scholar 

  21. •• Arif-Tiwari H, Twiss CO, Lin FC, Funk JT, Vedantham S, Martin DR, Kalb BT (2018) Improved detection of pelvic organ prolapse: comparative utility of defecography phase sequence to nondefecography valsalva maneuvers in dynamic pelvic floor magnetic resonance imaging. Curr Probl Diagn Radiol This study compared defecatory (evacuation) and nondefecatory (valsalva maneuver) images in 237 symptomatic women. They demonstrated significantly more cystoceles on defecatory images (83.1%) with a median bladder descent of 3.4 cm below PCL durig evacuation compared to cystoceles seen on nondefecatory images (45.6%) with a median descent of 1 cm below PCL during valsalva maneuver alone.

  22. Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175(1):10–7.

    Article  CAS  Google Scholar 

  23. McGuire EJ, Fitzpatrick CC, Wan J, Bloom D, Sanvordenker J, Ritchey M, et al. Clinical assessment of urethral sphincter function. J Urol. 1993;150(5 Pt 1):1452–4.

    Article  CAS  Google Scholar 

  24. Kobi M, Flusberg M, Paroder V, Chernyak V. Practical guide to dynamic pelvic floor MRI. J Magn Reson Imaging. 2018;47(5):1155–70.

    Article  PubMed  Google Scholar 

  25. Macura KJ, Genadry RR, Bluemke DA. MR imaging of the female urethra and supporting ligaments in assessment of urinary incontinence: spectrum of abnormalities. Radiographics. 2006;26(4):1135–49.

    Article  PubMed  Google Scholar 

  26. •• Macura KJ, Thompson RE, Bluemke DA, Genadry R. Magnetic resonance imaging in assessment of stress urinary incontinence in women: parameters differentiating urethral hypermobility and intrinsic sphincter deficiency. World J Radiol. 2015;7(11):394–404. This study correlated dMRI with urodynamic findings in 21 patients with stress urinary incontinence and compared the findings with 10 continent patients. They showed the importance of dMRI in identifying the contributions from UH and sphincteric dysfunction in patients with stress urinary incontinence.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kim JK, Kim YJ, Choo MS, Cho KS. The urethra and its supporting structures in women with stress urinary incontinence: MR imaging using an endovaginal coil. AJR Am J Roentgenol. 2003;180(4):1037–44.

    Article  PubMed  Google Scholar 

  28. Tunn R, Paris S, Fischer W, Hamm B, Kuchinke J. Static magnetic resonance imaging of the pelvic floor muscle morphology in women with stress urinary incontinence and pelvic prolapse. Neurourol Urodyn. 1998;17(6):579–89.

    Article  CAS  Google Scholar 

  29. Bitti GT, Argiolas GM, Ballicu N, Caddeo E, Cecconi M, Demurtas G, et al. Pelvic floor failure: MR imaging evaluation of anatomic and functional abnormalities. Radiographics. 2014;34(2):429–48.

    Article  PubMed  Google Scholar 

  30. Khatri G, Carmel ME, Bailey AA, Foreman MR, Brewington CC, Zimmern PE, et al. Postoperative imaging after surgical repair for pelvic floor dysfunction. Radiographics. 2016;36(4):1233–56.

    Article  PubMed  Google Scholar 

  31. •• Alt CD, Benner L, Mokry T, Lenz F, Hallscheidt P, Sohn C, et al. Five-year outcome after pelvic floor reconstructive surgery: evaluation using dynamic magnetic resonance imaging compared to clinical examination and quality-of-life questionnaire. Acta Radiol. 2018. This study of 26 women undergoing 104 dMRI over a 5-year postoperative period demonstrated that clinical exam may be more sensitive than dMRI in diagnosis of recurrent or de novo POP in the anterior compartment. The authors also showed that dMRI was significantly superior to clinical exam for diagnosing recurrent multicompartment defects and POP in the posterior compartment.

    Article  Google Scholar 

  32. Gousse AE, Barbaric ZL, Safir MH, Madjar S, Marumoto AK, Raz S. Dynamic half Fourier acquisition, single shot turbo spin-echo magnetic resonance imaging for evaluating the female pelvis. J Urol. 2000;164(5):1606–13.

    Article  CAS  Google Scholar 

  33. Gupta S, Sharma JB, Hari S, Kumar S, Roy KK, Singh N. Study of dynamic magnetic resonance imaging in diagnosis of pelvic organ prolapse. Arch Gynecol Obstet. 2012;286(4):953–8.

    Article  PubMed  Google Scholar 

  34. •• Ramage L, Georgiou P, Qiu S, McLean P, Khan N, Kontnvounisios C, et al. Can we correlate pelvic floor dysfunction severity on MR defecography with patient-reported symptom severity? Updat Surg. 2017. This study of 170 patients to assess whether dMRI findings correlated with patient-reported symptom severity using pretreatment questionnaire showed that overall there was poor correlation.

    Article  Google Scholar 

  35. • Rosenkrantz AB, Lewis MT, Yalamanchili S, Lim RP, Wong S, Bennett GL. Prevalence of pelvic organ prolapse detected at dynamic MRI in women without history of pelvic floor dysfunction: comparison of two reference lines. Clin Radiol. 2014;69(2):e71–7. This study included 60 women without pelvic floor dysfunction symptoms who underwent a limited dMRI which included strain images. The authors observed that POP may be present in asymptomatic patients, suggesting that clinical findings should always be correlated with dMRI findings.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Ayushi P. Gupta.

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Conflict of Interest

Ayushi Gupta, Prerna Raj Pandya, My-Linh Nguyen, Tola Fashokun, and Katarzyna J. Macura each declare no potential conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on New Imaging Techniques

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Gupta, A.P., Pandya, P.R., Nguyen, ML. et al. Use of Dynamic MRI of the Pelvic Floor in the Assessment of Anterior Compartment Disorders. Curr Urol Rep 19, 112 (2018).

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