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MRI IN Pelvic Floor Disorders

MRI IN Pelvic Floor Disorders

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MRI IN Pelvic Floor Disorders

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  1. MRIINPelvic Floor Disorders MAHYAR GHAFOORI M.D. Associate Professor of Radiology Tehran University Of Medical Sciences

  2. Pelvic floor in Women • Anterior Compartment: Bladder & Urethra • Middle Compartment: Uterus & Vagina • Posterior Compartment: Anorectal

  3. Normal Anatomy

  4. Reference Lines Pubococcygeal line (PCL): From the inferior border of pubic symphysis to the last coccygeal joint. Level of Pelvic Floor H line: Max. 5 cm From inferior border of pubic symphysis to the posterior wall of the rectum at the level of anorectal junction. AP Width of Levator Hiatus M line:Max. 2 cm Perpendicularly from PCL to the most posterior aspect of H line. Vertical descent of the levator hiatus

  5. Rest Straining Normal

  6. Rest Straining 71 Y/O F: Prolapse & Fecal Incontinence

  7. Prolapse Severity Grading Prolapse of an organ below the PCL: 3 cm or less Mild Between 3 and 6 cm Moderate More than 6 cm Severe

  8. Anorectal Angle Rest 108 - 127° Squeezing Close Defecation Open

  9. Puborectalis Muscle Rest Squeezing Straining

  10. Anterior Compartment Cystocele Urethral Hypermobility

  11. Rest Strain 33mm 0° 18mm 65° 48 Y/O Stress urinary incontinence & frequency

  12. 56 Y/O F: Stress urinary incontinence, feeling of incomplete bladder voiding, ODS

  13. Middle Compartment Uterine or Vaginal Vault Prolapse

  14. Rest Straining Defecation 41 Y/O F: Severe uterine prolapse

  15. Rest Defecation 72 Y/O F: Prolapse after Hysterectomy

  16. Posterior Compartment

  17. Anterior Rectocele 45 Y/O F: history of obstructed defecation

  18. Posterior Rectocele During Defecation 41 Y/O F with ODS

  19. Rectocele During Defecation Intrarectal Residue 65 Y/O F: History of incomplete evacuation

  20. IntrarectalInvagination 57 Y/O F: Feeling of incomplete evacuation

  21. Extraanal Invagination (Rectal Prolapse) Rest Progressive Straining 63 Y/O F: Fecal Incontinence, Hx of Hysterectomy

  22. Enterocele Early Defecation Late Defecation 64 Y/O F: Prolapse after Hysterectomy

  23. 3 Compartment Prolapse Complete Defecation During Defecation 68 Y/O F: Perineal descent, ODS

  24. 3 Compartment Prolapse Rest Squeezing Defecation 62 Y/O F: 3 Compartment Descent

  25. Progressive Straining 65 Y/O F: ODS, Hx of Hysterectomy

  26. Spastic Pelvic Floor Syndrome(Pelvic Floor Uncoordination, Anismus) Functional abnormality. Involuntary, inappropriate & paradoxical contraction of striated pelvic floor musculature: evacuation failure & Constipation. Paradoxical contraction of puborectalis muscle. Puborectalismuscle is hypertrophic & makes an impression on posterior rectal wall during defecation. Etiology is unclear (Abnormal muscle activity, psychologic, cognitive) AnorectalManometry: Increased pressure at rest & during defecation. Pathologic signals at electromyography.

  27. Spastic Pelvic Floor Syndrome Rest Strain 51 Y/O M: ODS

  28. Progressive Straining Rest 68 Y/O F: Excessive straining & incomplete evacuation

  29. The End Mahyar Ghafoori M.D.