Abstract
Purpose
The aim of this study was to compare the diagnostic efficacy of dynamic MR defecography (MR-D) with entero-colpo-cysto-defecography (ECCD) in the assessment of midline pelvic floor hernias (MPH) in female pelvic floor disorders.
Methods
From August 2004 to August 2010, 3,006 female patients who required ECCD for the evaluation of pelvic floor disorders were enrolled in this study. All the 1,160 patients with ECCD findings of MPH were asked to undergo MR-D; 1,142 accepted to undergo MR-D and constituted the object of analysis. This study was approved by the Institutional Ethical Committee. All the patients gave their written informed consent to take part in the study.
Results
Overall, the prevalence of MPH at ECCD was higher if compared with that at MR-D. Concerning the hernia content, there were significantly more enteroceles and sigmoidoceles on ECCD than on MR-D, whereas, in relation to the hernia development modalities, the prevalence of elytroceles, edroceles, and Douglas' hernias at ECCD was significantly higher than that at MR-D. In spite of a 100% specificity, the sensibility of MR-D in the detection of an omentocele, sigmoidocele, and enterocele was, respectively, 95%, 82%, and 65%, showing an inferior diagnostic capacity if compared with that of ECCD.
Conclusion
MR-D shows lower sensitivity than ECCD in the detection of MPH development. The less-invasive MR-D may have a role in a better evaluation of the entire pelvic anatomy and pelvic organ interaction especially in patients with multicompartmental defects, planned for surgery.
Similar content being viewed by others
References
Weber AM, Abrams P, Brubaker L, Cundiff G, Davis G, Dmochowski RR, Fischer J, Hull T, Nygaard I, Weidner AC (2001) The standardization of terminology for researchers in female pelvic floor disorders. Int Urogynecol J 12:178–186
Sung VW, Hampton BS (2009) Epidemiology of pelvic floor dysfunction. Obstet Gynecol Clin N Am 36:421–43
Torricelli P, Pecchi A, Caruso Lombardi A, Vetruccio E, Vetruccio S, Romagnoli R (2002) Magnetic resonance imaging in evaluating functional disorders of female pelvic floor. Radiol Med 103:488–500
Oom DM, Gosselink MP, Schouten WR (2009) Enterocele-diagnosis and treatment. Gastroentérol Clin Biol 33:135–7
Reginelli A, Pezzullo MG, Scaglione M, Scialpi M, Brunese L, Grassi R (2008) Gastrointestinal disorders in elderly patients. Radiol Clin N Am 46:755–771
Law YM, Fielding JR (2008) MRI of pelvic floor dysfunction: review. AJR 191:S45–S53
Vanbeckevoort D, Van Hoe L, Oyen R, Ponette E, De Ridder D, Deprest J (1999) Pelvic floor descent in females: comparative study of colpocystodefecography and dynamic fast MR imaging. J Magn Reson Imaging 9:373–377
Blandino A, Rotondo A, Danza F, Menchi I, Pozzi Mucelli R (2010) Imaging delle disfunzioni del pavimento pelvico in: Imaging dell'Apparato Urogenitale Patologia non oncologica, 1st edn. Springer.
Kelvin FM, Maglinte DDT, Hale DS, Benson JT (2000) Female pelvic organ prolapse: a comparison of triphasic dynamic MR imaging and triphasic fluoroscopic cystocolpoproctography. AJR Am J Roentgenol 174(1):81–8
Comiter CV, Vasavada SP, Barbaric ZL, Gousse AE, Raz S (1999) Grading pelvic prolapse and pelvic floor relaxation using dynamic magnetic resonance imaging. Urology 54:454–457
Kelvin FM, Hale DS, Maglinte DDT, Patten BJ, Benson JT (1999) Female pelvic organ prolapse: diagnostic contribution of dynamic cystoproctography and comparison with physical examination. AJR 173:31–37
Yang A, Mostwin JL, Rosenheim NB, Zerhouni EA (1991) Pelvic floor descent in women: dynamic evaluation with fast MR imaging and cinematic display. Radiology 179:25–33
Lienemann A, Anthuber A, Baron A, Kohz P, Reiser M (1997) Dynamic MR colpocystorectography assessing pelvic-floor descent. Eur Radiol 7:1309–17
Beer-Gabel M, Teshler M, Schechtman E, Zbar AP (2004) Dynamic transperineal ultrasound vs. defecography in patients with evacuatory difficulty: a pilot study. Int J Colorectal Dis 19:60–67
Cavallo G, Salzano A, Grassi R, Zanatta P, Tuccillo M (1991) Rectocele in males: clinical, defecographic, and CT study of singular cases. Dis Colon Rectum 34(11):964–6
Grassi R, Lombardi G, Reginelli A, Capasso F, Romano F, Floriani I, Colacurci N (2007) Coccygeal movement: assessment with dynamic MRI. Eur J Radiol 61:473–9
Healy JC, Halligan S, Reznek RH, Watson S, Bartram CI, Phillips R, Armstrong P (1997) Dynamic MR imaging compared with evacuation proctography when evaluating anorectal configuration and pelvic floor movement. AJR Am J Roentgenol 169:775–9
Kelvin FM, Maglinte DDT, Hornback JA, Benson JT (1992) Pelvic prolapse: assessment with evacuation proctography (defecography). Radiology 184:547–551
Cl B, Tumbull GK, Lennard-Jones JE (1988) Evacuation proctography: an investigation of rectal expulsion in 20 subjects without defecation disturbance. Gastrointest Radiol 3:72–80
Faccioli N, Comai A, Mainardi P, Perandini S, Farah M, Pozzi-Mucelli R (2010) Defecography: a practical approach. Diagn Interv Radiol 16:209–216
Pannu HK, Scatarige JC, Eng J (2009) Comparison of supine magnetic resonance imaging with and without rectal contrast to fluoroscopic cystocolpoproctography for the diagnosis of pelvic organ prolapse. J Comput Assist Tomogr 33:125–130
Brubaker L, Heit MH (1993) Radiology of the pelvic floor. Clin Obstet Gynecol 36:952–959
Maillard E, Henry L, Mion F, Barth X, Tissot E, Mellier G, Damon H (2008) Elytrocele with and without a history of hysterectomy (303 defecography studies). Gastroentérol Clin Biol 32:953–9
Dodi G (1994) “Colonproctologia ambulatoriale:trattatto per chirurghi, gastroenterologi e madici pratici” Piccin
Guglielmi G, Schiavon F, Cammarota T (2006) Radiologia geriatrica. Springer, Italia
Cordiano C, D'Amico DF (1981) Manuale di Chirurgia d'urgenza. Piccin
McNevin MS (2010) Overview of pelvic floor disorders. Surg Clin N Am 90:195–205
Stoker J, Halligan S, Bartram CI (2001) Pelvic floor. Imaging radiol 218:621–641
Elshazly WG, El Nekady, Ael A, Hassan H (2010) Role of dynamic magnetic resonance imaging in management of obstructed defecation case series. Int J Surg 8:274–82
Rentsch M, Paetzel Ch, Lenhart M, Feuerbach S, Jauch KW, Furst A (2001) Dynamic magnetic resonance imaging defecography: a diagnostic alternative in the assessment of pelvic floor disorders in proctology. Dis Colon Rectum 44:999–1007
Matsuoka H, Wexner SD, Desai MB, Nakamura T, Nogueras JJ, Weiss EG, Adami C, Billotti VL (2001) A comparison between dynamic pelvic magnetic resonance imaging and videoproctography in patients with constipation. Dis Colon Rectum 44:571–576
Goei R, Kemerink G (1990) Radiation dose in defecography. Radiology 176:137–139
Bertschinger KM, Hetzer FH, Roos JE, Treiber K, Marincek B, Hilfiker PR (2002) Dynamic MR imaging of the pelvic floor performed with patient sitting in an open-magnet unit versus with patient supine in a closed-magnet unit. Radiology 223:501–8
Beer-Gabel M, Assoulin Y, Amitai M, Bardan E (2008) A comparison of dynamic transperineal ultrasound (DTP-US) with dynamic evacuation proctography (DEP) in the diagnosis of cul de sac hernia (enterocele) in patients with evacuatory dysfunction. Int J Colorectal Dis 23:513–19
Pescatori M, Zbar AP (2009) Reintervention after complicated or failed STARR procedure. Int J Colorectal Dis 24:87–95
Maglinte DD, Bartram CI, Hale DA, Park J, Kohli MD, Robb BW, Romano S, Lappas JC (2011) Functional imaging of the pelvic floor. Radiology 258:23–39
Hale D (2008) Clinical and surgical pelvic organ prolapse. In: Bartram CI, DeLancey JOL (eds) Medical radiology. Diagnostic and radiation oncology: pelvic floor disorders, 2nd edn. Springer, Heidelberg
Benson TJ (1991) The compartmentalization of the female pelvic floor. Int Urogynecol J 2:95
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cappabianca, S., Reginelli, A., Iacobellis, F. et al. Dynamic MRI defecography vs. entero-colpo-cysto-defecography in the evaluation of midline pelvic floor hernias in female pelvic floor disorders. Int J Colorectal Dis 26, 1191–1196 (2011). https://doi.org/10.1007/s00384-011-1218-4
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-011-1218-4