Comparison of magnetic resonance defecography with pelvic floor ultrasound and vaginal inspection in the urogynecological diagnosis of pelvic floor dysfunction

Abstract

Introduction: The aim of the study is to evaluate the use of pelvic floor (PF) ultrasound and vaginal inspection in the quantification of prolapse and to compare findings with magnetic resonance (MR) defecography in a blind study. Materials and Methods: Data from the dynamic MR imaging (MRI) defecography were compared and evaluated with PF ultrasound and vaginal examinations (VEs) in 45 female patients aged from 52 to 94, between the years 2016 and 2018. With regard to the pelvic organ prolapse (POP), MRI defecography revealed changes in the mid-pubic line. According to Bump et al., the bladder neck descent, degree of the retrovesical angle, and urethral rotation were measured to identify anterior vaginal wall descent extent. POP quantification (POP-Q) was determined by VE. Results: With regard to the presence of a Grade II prolapse in the anterior and posterior vaginal walls, the intraclass correlation coefficient (ICC) showed a significant correspondence (ICC = 0.85, 95% confidence interval [CI] 0.67-0.92), (ICC = 0.77, 95% CI 0.63-0.88). With regard to the accordance in the ICC between the VE results (POP-Q) and the dynamic MRI defecography, there was an excellent match in high Grade III and IV in all compartments. In addition to bladder neck funneling, hypermobility of the urethra was identified by ultrasound in seven women (n 7/45, 15.5%). Conclusion: Despite different reference systems in the quantification of results, both the methods allow for a similarly successful separate assessment of all three compartments. The agreement between methods and interobserver agreement for the clinical diagnosis is good. Based on the results, we would recommend the supplemental dynamic PF ultrasound for part of the noninvasive examination for the diagnosis of POP.