Pelvic Relaxation on Dynamic MR Defecography DR.AFAK DURUR - - PowerPoint PPT Presentation

Pelvic Relaxation

• n Dynamic MR

Defecography

DR.AFAK DURUR KARAKAYA

Introduction

Dynamic magnetic resonance defecography (DMRD) can provide anatomical and functional information of the pelvic region and defecation.

Objective/Purpose

To describe the grading system of DMRD and to demonstrate some special findings of pelvic relaxation.

MR technique

• 240-mL of sonography gel was instilled into the rectum by means of a

small rectal catheter with the patient in the right decubitus position.

• Axial, coronal and sagittal T2-weighted sequence
• Four dynamic phases were acquired.
• These phases are :
• Rest,
• Maximal sphincter contraction
• Maximal strain,
• Defecation
• There was a rest period of 2 seconds between these phases.

Rest

Rest

Maximal sphincter contraction

Maximal sphincter contraction

Maximal strain

Maximal strain

Defecation

Defecation

Results

Minimal Moderate Severe Anterior 16 16 2 Middle 3 13 19 Posterior 3 20 39

• 63 patients assessed
• The affected compartments were posterior 62, middle 35 and anterior 36
• In addition
• Spastic pelvic floor syndrome (19)
• Rectocele (55)
• İntussuception (28)
• Enterocele (3)
• Hypermobility of uretra (1)

Image analyses Image analyses Image analyses Image analyses

• Pelvic floor is divided into three

compartments:

• The anterior compartment
• (the lower urinary tract)
• The middle compartment
• (the vagina/uterus),
• And the posterior compartment
• (the ano rectum).

A

M P

Image Image Image Image analyses analyses analyses analyses

• The pubococcygeal line is drawn from the

inferior border of the pubic symphysis to the last coccygeal articulation.

• We have measured in centimeters

The urine bladder base (anterior compartment) The cervico vaginal junction or the vaginal cuff (middle compartment) The anorectal junction (posterior compartment).

Image Image Image Image analyses analyses analyses analyses

• Grading of pelvic floor descent is described.

Anterior/Middle/ Posterior

Mild 2-4 Modarate 4-6 Severe > 6 cm

Pathologies

Pathologies

Pathologies

During defecation there is severe descent of the anorectal junction which is located below the pubococcygeal line. In addition, enterocele and anterior rectocele.

Pelvic Relaxation

Pelvic floor relaxation can be described by abnormal hiatal enlargement and pelvic floor descent during maximal strain. Pelvic floor relaxation occurs as the fascial and muscular supports of the pelvic floor when it is weakened over time. As the pelvic floor relaxation increases, the pelvic organs supported are also more likely to descend, indicating weakening of their supportive fascia and ligaments.

Conclusion

• DMRD is a very effective and reliable method in

the diagnosis and treatment efficiency of the functional pelvic floor diseases because it provides both anatomical and functional information and it does not include any ionizing radiation.

References

Thapar RB, Patankar RV, Kamat RD, Thapar RR, Chemburkar V. MR defecography for obstructed defecation syndrome. Indian J Radiol Imaging. 2015 Jan- Mar;25(1):25-30. Pomian A, Lisik W, Kosieradzki M, Barcz E. Obesity and Pelvic Floor Disorders:A Review of the

• Literature. Med Sci Monit.

2016:3; 22:1880-6. Foti PV, Farina R, Riva G ve ark. Pelvic floor imaging: comparison between magnetic resonance imaging and conventional defecography in studying outlet

• bstruction syndrome. Radiol
• Med. 2013; 118:23-39