Dynamic MRI in the assessment of female pelvic organ prolapse: Baseline and post-surgical evaluation

Learning Objectives: To assess the diagnostic role of MRI in the evaluation of female urinary incontinence and pelvic organ prolapse using dynamic MRI, as a baseline assessment and after surgery using “Patch and Plug” technique. Background: Dynamic MRI examination of pelvic prolapse is a good aid in the evaluation of both the type and degree of the female pelvic organ prolapse, representing a diagnostic confirmation of the clinical assessment. It is also useful to demonstrate prolapse has disappeared after surgery. MRI provides a complete evaluation of the pelvic organs by both static and dynamic imaging; it may also allow evaluation of the muscular and ligamentous structures of the pelvic floor. Procedure Details: 44 patients with genuine stress urinary incontinence and genital prolapse were investigated by standard and dynamic MRI, using a 1.5Tunit. Patients were placed in a supine position with the legs slightly flexed and abducted; 250ml of Gd-DTPA water solution were instilled into the bladder, 20ml of Gd water-gel solution was injected into the vagina and 50ml into the rectum. Dynamic images were obtained at rest and during Valsalva manoeuvre, using T1-FFE sequences on sagittal plane. Dynamic MRI was analyzed to determine the presence and extent of cystocele and vaginal vault prolapse. Conclusion: Dynamic MRI provided a good demonstration of genital prolapse during Valsalva manoeuvre in all cases; a good correlation with the clinical evaluation of both genital prolapse type and degree was found in the baseline assessment and after surgery.