The role of dynamic magnetic resonance imaging in the diagnosis of pelvic organ prolapse

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Abstract

Dynamic magnetic resonance imaging (dMRI) of the pelvic floor is a valuable tool for diagnosing pelvic organ prolapse. It provides a comprehensive assessment of all anatomical and functional characteristics of the pelvic walls and pelvic organs. Despite the advantages of dMRI, there remains much debate regarding its diagnostic accuracy and correlation with clinical findings. This review presents an analysis of the literature on the capabilities and limitations of dMRI in the diagnosis of pelvic organ prolapse. The etiology, pathogenesis, clinical presentation, and diagnosis of this pathology were reviewed. Dynamic pelvic floor MRI provides a comprehensive assessment of the anatomical and functional characteristics of the pelvis, while being free of ionizing radiation. This method makes it possible to assess the evacuatory function of the visualized structures in dynamics. Simultaneous visualization of all three parts of the pelvic floor using dMRI enables the assessment of multicompartmental disorders, allowing surgical correction in approximately 67% of the cases. Image interpretation is discussed, beginning with viewing three orthogonal T2-weighted sequences acquired at rest to assess baseline anatomy and pelvic organ positioning. Dynamic images were then studied to assess the position of the pelvic organs in relation to the pelvic bones during different phases of straining and gel evacuation from the intestine and vagina.

Conclusion: dMRI is characterized by a high resolution and reproducibility. It allows the identification of the pathology of organs and supporting structures of all pelvic areas. dMRI is characterized by a high correlation between acquired findings and clinical data, which is important for patients with a complicated medical history or ambiguous clinical findings, as well as for multicompartment disorders.

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About the authors

Aida V. Gilyadova

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University); National Medical Research Center "Medical Rehabilitation Center", Ministry of Health of Russia

Author for correspondence.
Email: benyagueva@mail.ru
ORCID iD: 0000-0003-4343-4813

Assistant at the Department of Oncology, Radiotherapy and Plastic Surgery; obstetrician-gynecologist

Russian Federation, Moscow; Moscow

Anton A. Ishchenko

National Medical Research Center "Medical Rehabilitation Center", Ministry of Health of Russia

Email: ra2001_2001@mail.ru
ORCID iD: 0000-0001-6673-3934

PhD, Head of the Clinic of Gynecology, Reproductive and Aesthetic Medicine

Russian Federation, Moscow

Igor V. Reshetov

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: reshetoviv@mail.ru
ORCID iD: 0000-0002-0909-6278

Academician of the RAS, Dr. Med. Sci., Professor, Head of the Department of Oncology, Radiotherapy and Plastic Surgery, N.V. Sklifosovsky Institute of Clinical Medicine; Director of the Institute of Cluster Oncology named after Prof. L.L. Levshin

Russian Federation, Moscow

Anatoly I. Ishchenko

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: 7205502@mail.ru
ORCID iD: 0000-0003-3338-1113

Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology No.1; Director of the V.F. Snegirev Obstetrics and Gynecology Clinic

Russian Federation, Moscow

Inna A. Apolikhina

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University); Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: i_apolikhina@oparina4.ru
ORCID iD: 0000-0002-4581-6295

Dr. Med. Sci., Professor, Head of the Department of Aesthetic Gynecology and Development; Professor of the Department of Obstetrics, Gynecology, Perinatology and Reproductology, Institute of Vocational Education

Russian Federation, Moscow; Moscow

Aina S. Saidova

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: a_saidova@oparina4.ru
ORCID iD: 0000-0003-3473-3109

PhD, obstetrician-gynecologist of the Department of Aesthetic Gynecology and Fetus

Russian Federation, Moscow

Elena N. Puchkova

Lapino Clinical Hospital of the "Mother and Child" Group of Companies

Email: milleyk@mail.ru
ORCID iD: 0000-0002-7743-0549

PhD, radiologist of the highest category

Russian Federation, Moscow region

Viktor S. Petrovichev

National Medical Research Center "Medical Rehabilitation Center", Ministry of Health of Russia

Email: petrovi4ev@gmail.com
ORCID iD: 0000-0002-8391-2771

PhD, Head of the Imaging Department, Center for Radiation Diagnostics

Russian Federation, Moscow

Elena A. Mershina

Medical Research and Education Centre of Lomonosov Moscow State University

Email: elena_mershina@mail.ru
ORCID iD: 0000-0002-1266-4926

PhD, Associate Professor, Department of Radiation Diagnostics and Radiation Therapy; Head of the Department of X-ray Diagnostics with MRI and CT Departments

Russian Federation, Moscow

Muminat F. Novruzalieva

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: ms.muminat@bk.ru
ORCID iD: 0000-0003-4654-9405

student, Faculty of Medical Medicine

Russian Federation, Moscow

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Supplementary files

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2. Figure 1. U-shaped puborectal muscle, in the form of a loop, covers the urethra, vagina and rectum, forming the urogenital gap

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3. Fig. 2 Normal indicators of the state of the pelvic organs: A - anorectal angle at rest, B - anorectal angle with straining and relaxing the puborectal muscle, C - anorectal angle with tension of the puborectal muscle

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4. Fig.3. Evaluation of parameters of the pelvic organs in the norm relative to the LCL, H- and M-lines

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5. Fig.4. Normal location of the bladder fundus and urethral axis relative to the LCL at rest

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6. Fig.5. Normal indicators of the location of the cervix at rest relative to the LCL, H- and M-lines

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7. Fig.6. Severe cystocele on straining

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8. Fig.7. Horizontal arrangement, expansion, gaping of the urethra; downward displacement of the anorectal junction with the formation of intussusception

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9. Fig.8. Prolapse of the middle compartment on dMRI with straining: cystocele, horizontal position of the urethra, central prolapse, displacement of the uterus into the vagina, lengthening of the H- and M-lines.

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