女性盆腔器官脱垂病人肛提肌的MRI评价

盆腔器官脱垂是指由于盆底支持结构薄弱而导致盆腔脏器脱离正常的解剖位置。肛提肌是盆底支持结构中的重要组成部分,其结构损伤及功能障碍是盆腔器官脱垂的重要致病原因,因此对肛提肌的解剖结构进行详细描述成为盆腔器官脱垂研究的关键。动态MRI、扩散张量成像和纤维束示踪技术以及三维有限元分析等MRI技术能够提供肛提肌形态、运动、功能、微观结构以及生物力学等方面的信息,对于探索盆腔器官脱垂发病机制、完善其临床诊断和治疗具有重要的价值。     

女性压力性尿失禁的动态MRI表现

目的分析正常女性及压力性尿失禁(stress urinary incontinence,SUI)患者尿道周围支持结构的动态MRI表现,以评价动态MRI在SUI诊断中的作用。资料与方法对28名女性志愿者及16例SUI患者行盆腔动态MRI检查。通过肉眼观察和数据测量,评价静息及屏气用力状态下正常志愿者和SUI患者尿道支持结构及其功能状态的变化。结果女性尿道支持韧带有4组,包括尿道周围韧带、尿道旁韧带、耻骨尿道韧带和尿道下韧带;肛提肌有3对,即耻骨尾骨肌、耻骨直肠肌及髂骨尾骨肌。正常志愿者用力前后尿道支持韧带及肛提肌各组成部分形态无明显变化。SUI患者尿道支持韧带表现为一组或多组韧带不同程度松弛或断裂,屏气用力状态下上述改变仍存在,无显著性变化;肛提肌在静息状态下形态学表现与正常志愿者相近,但在屏气用力状态下肛提肌表现为松弛;尿道活动度较正常女性增大。结论 MRI可以较好显示尿道支持韧带及肛提肌的形态,动态MRI可以更好地评价尿道支持结构的功能状态。     

正常肛提肌用力前后SCT、MRI形态变化研究

目的:通过用力前后SCT、MRI影像评价正常妇女肛提肌的形态与功能.方法:对56例无骨盆手术史且无盆底功能性疾病的绝经前未产妇进行盆底动态SCT、MRI扫描,研究肛提肌的组成、起止点、位置、耻骨直肠肌厚度以及功能.结果:肛提肌整体上由许多细小的带状肌束呈叠瓦状相互覆盖、铺展而成的一对四边形的薄片肌.一般分为:耻骨阴道肌、耻骨直肠肌、耻骨尾骨肌及髂骨尾骨肌四部分.用力时均向外下呈弧形伸长变薄.静息时测得右侧耻骨直肠肌厚度平均为(2.57±1.1 6)mm,左侧为(2.53±1.37)mm,用力时右侧厚度平均为(1.98±0.68)mm,左侧为(1.96±0.82)mm,SCT和MRI测量结果具有很好的一致性.结论:SCT、MRI扫描能直接清楚地显示肛提肌的解剖结构和大体形态,并可利用图像对耻骨直肠肌进行定性和定量分析其结构的变化,准确地反映耻骨直肠肌的功能状态,为直观地了解和评估该肌群的发育及结构异常提供一条新途径,为手术治疗及评价术后排便功能提供客观依据.     

无盆底功能障碍女性肛提肌动态磁共振成像观察

目的：探讨无盆底功能障碍女性肛提肌功能和形态变化特征。方法对20名无盆底功能障碍性疾病志愿者行盆腔动态磁共振成像（MRI）检查,测量在静息位及最大腹压时肛提肌裂隙面积、双侧耻骨直肠肌厚度、肛提肌板角度及其变化值。结果肛提肌裂隙面积：静息位（9257±1234）mm2,最大腹压（10380±1395） mm2,差异有统计学意义（P＜0．05）。耻骨直肠肌厚度：静息位（5．9±0．8）mm,最大腹压（4．7±0．6）mm,差异有统计学意义（P＜0．05）;左、右侧耻骨直肠肌厚度不对称：静息位分别为（6．0±0．8）mm、（5．8±0．7）mm,最大腹压分别为（4．8±0．7）mm、（4．6±0．6）mm,差异有统计学意义（P＜0．05）。肛提肌板角度：静息位（40±4）°,最大腹压（46±4）°,差异有统计学意义（P＜0．05）,其变化值为（6．0±1．6）°。结论动态MRI检查可以直观地观察肛提肌的形态,评价肛提肌的功能。     

肛提肌影像学研究进展

近年来,盆底MRI动态成像已经可以显示肛提肌的活体形态变化,但是,影像学显示的肛提肌活体形态变化与传统的肛提肌功能理论之间出现了一些无法解释的矛盾,一系列新的肛提肌影像学征象的生理学意义尚需进一步研究.综述了目前肛提肌影像学的研究进展.     

肛提肌影像学研究进展

近年来，盆底MRI动态成像已经可以显示肛提肌的活体形态变化，但是，影像学显示的肛提肌活体形态变化与传统的肛提肌功能理论之间出现了一些无法解释的矛盾，一系列新的肛提肌影像学征象的生理学意义尚需进一步研究。综述了目前肛提肌影像学的研究进展。     

MRI与超声诊断盆腔器官脱垂的临床应用分析

目的 探讨MRI与超声检查应用于盆腔器官脱垂(POP)的临床应用价值。方法 选取100例盆底功能障碍性疾病患者,将其纳入观察组。另外选取同时期在本院行健康体检的80例受检者,将其纳入对照组,均行盆底超声检查和MRI检查,评价两种检查方式的诊断效能。结果 超声检查和MRI对静息状态、肛提肌裂孔收缩状态及最大Valsava状态下不同组间受检者肛提肌裂孔形态的变化差异有统计学意义(P<0.05),无论是超声检查还是MRI检查,观察组肛提肌裂孔周长、面积均高于对照组,差异有统计学意义(P<0.05),超声检查和MRI检查与金标准的一致性较强;超声检查的灵敏度为84.38%,低于MRI检查的95.29%;MRI诊断的特异度为90.00%,高于超声检查的67.86%,两者比较差异有统计学意义(P<0.05),但超声检查诊断的AUC值高于MRI。结论 盆底超声检查和MRI应用于POP诊断中均具有不可替代的作用,相比之下超声检查更简便易行,可重复性更高。     

MRI对分娩并发肛提肌损伤的评价研究

目的探讨女性正常肛提肌与肛提肌损伤的MRI表现，评价分娩与肛提肌损伤的相关性。方法选择100例健康未产妇（对照组）和200例经阴道分娩初产妇（研究组），研究组进一步分为压力性尿失禁组（研究A组）和无症状组（研究B组）各100例。采用MR质子加权像对其盆部进行多方位扫描，比较正常肛提肌与其损伤的MRI特征。结果对照组肛提肌均表现正常，研究组中54例（27％）（研究A组42例，研究B组12例）有明显的肛提肌损伤，其中49例位于耻骨直肠肌，5例位于髂骨尾骨肌（x^2=41．447，P〈0．01）。耻骨直肠肌损伤多表现为单侧或双侧部分缺损，髂骨尾骨肌损伤表现为肌肉明显萎缩。结论经阴道分娩是引起肛提肌损伤的重要原因，其损伤可导致盆腔器官脱垂和盆底功能障碍性疾病，初产妇肛提肌损伤多发生于耻骨直肠肌，MRI是检测肛提肌损伤的有效手段。     

静动态MRI在盆腔器官脱垂术前与术后中的应用

目的：探讨静动态 MRI 在盆腔器官脱垂(POP)术前诊断、术后疗效评价中的价值。方法经盆腔器官脱垂量化分度法(POP-Q)诊断为 POP 的患者29例,对照组为年龄、产次和体质量与之匹配的无症状志愿者12例,行静态和动态盆底 MRI 检查,观察盆底结构形态学变化,测量 POP 患者术前、术后及对照组动态 MRI 图像上各指标：膀胱下缘到耻尾线(PCL)的垂直距离(B-PCL)、子宫颈到 PCL 的垂直距离(U-PCL)、Douglas 窝到 PCL 的垂直距离(D-PCL)、耻骨直肠肌裂孔线(H 线)、盆底肌下降距离(M 线)、肛提肌裂孔面积(LHS)、肛提肌板角度(LPA)、髂尾肌角度(ICA)、尿道倾斜角(UA)。结果POP 患者术前 MRI 上诊断膀胱膨出19例,子宫脱垂28例,直肠膨出4例,Douglas 窝疝14例,盆底松弛29例,发现肛提肌缺陷27例,耻骨宫颈筋膜缺陷24例。POP 患者术前 B-PCL、U-PCL、D-PCL、H 线、M 线、LHS、LPA、ICA 及 UA 等测量值均大于对照组,其差异均有非常显著意义(P <0.01);21例 POP 术后患者中,MRI 发现9例盆腔器官位置恢复正常,12例仍有脱垂;8例网片植入患者术后 MRI 显示网片无移位;POP患者术后 B-PCL、U-PCL、D-PCL、UA 测量值较术前缩小,其差异有统计学意义(P <0.05)。结论静动态 MRI 可全面评价 POP术前、术后盆底形态和功能改变,检出隐匿的脱垂和术后残存。     

经会阴三维超声观察便秘产妇产后盆底结构及功能改变

 目的 经会阴盆底三维超声动态观察便秘产妇的肛提肌裂孔解剖形态及功能改变。方法 选取2014-01至2016-12在妇产科定期行产后复查的女性120例(产后组),其中有便秘症状48例(便秘产妇),无便秘症状72例(无便秘产妇),同期选取未育的无便秘症状健康妇女100例(对照组)。所有妇女均进行经会阴盆底三维超声检查,观察并测量、比较各组妇女的盆底形态结构及特征,测量各组妇女在静息状态、缩肛动作和Valsalva动作3种状态下的肛提肌裂孔面积、周长及耻骨直肠肌厚度。结果 产后妇女盆底组织结构疏松,对照组妇女肛提肌裂孔结构完整紧凑。在静息状态、缩肛动作及Valsalva动作3种状态下,产后组妇女的肛提肌裂孔面积、周长及耻骨直肠肌厚度均明显大于对照组妇女(P<0.05)。产后组便秘产妇在各种状态下的肛提肌裂孔面积及周长均明显大于非便秘产妇(P<0.05);在缩肛动作时,便秘产妇的耻骨直肠肌厚度明显薄于非便秘产妇(t=2.41,P<0.05),其余状态下的耻骨直肠肌厚度两者间比较,差异均无统计学意义(P＞0.05)。结论 产后妇女盆底解剖结构发生重塑,经会阴三维超声能有效观察产后女性尤其便秘产妇盆底解剖结构与功能的变化。     

四维盆底超声在电刺激联合生物反馈结合盆底肌锻炼治疗压力性尿失禁疗效评估中的价值

目的:探讨四维盆底超声在电刺激联合生物反馈盆底肌锻炼治疗压力性尿失禁(SUI)疗效评估中的价值.方法:选择60例SUI患者,电刺激联合生物反馈盆底肌锻炼3个月后分析治疗效果;并于治疗前后采用经会阴四维盆底超声记录患者肛提肌裂孔面积、裂孔左右径、肛提肌厚度、膀胱颈移动度、膀胱尿道后角及尿道内口漏斗形成率.结果:治疗后,肛...     

MR imaging evaluation of perianal fistulas: spectrum of imaging features

Perianal fistulization is an inflammatory condition that affects the region around the anal canal, causing significant morbidity and often requiring repeated surgical treatments due to its high tendency to recur. To adopt the best surgical strategy and avoid recurrences, it is necessary to obtain precise radiologic information about the location of the fistulous track and the affected pelvic structures. Until recently, imaging techniques played a limited role in evaluation of perianal fistulas. However, magnetic resonance (MR) imaging now provides more precise information on the anatomy of the anal canal, the anal sphincter complex, and the relationships of the fistula to the pelvic floor structures and the plane of the levator ani muscle. MR imaging allows precise definition of the fistulous track and identification of secondary fistulas or abscesses. It provides accurate information for appropriate surgical treatment, decreasing the incidence of recurrence and allowing side effects such as fecal incontinence to be avoided. Radiologists should be familiar with the anatomic and pathologic findings of perianal fistulas and classify them using the St James's University Hospital MR imaging-based grading system.     

尸体盆底肛提肌形态MSCT成像分析

目的了解尸体盆底肛提肌影像学形态差异。方法 10具尸体(盆底尸体)标本,行多层螺旋CT盆部扫描后,观察盆底肛提肌形态。结果 1具尸体没有获得理想图像。另外9具尸体中,前部盆底都呈盆状;中部盆底是一个过度区;后部盆底,有4具尸体呈穹隆状,5具尸体呈盆状,其中1具伴有腹腔脏器进入盆腔。结论尸体后盆底的肛提肌形态差异与脂肪体积以及会阴体的厚度有关。     

Functional imaging of the pelvic floor

The clinical treatment of patients with anorectal and pelvic floor dysfunction is often difficult. Dynamic cystocolpoproctography (DCP) has evolved from a method of evaluating the anorectum for functional disorders to its current status as a functional method of evaluating the global pelvic floor for defecatory disorders and pelvic organ prolapse. It has both high observer accuracy and a high yield of positive diagnoses. Clinicians find it a useful diagnostic tool that can alter management decisions from surgical to medical and vice versa in many cases. Functional radiography provides the maximum stress to the pelvic floor, resulting in levator ani relaxation accompanied by rectal emptying-which is needed to diagnose defecatory disorders. It also provides organ-specific quantificative information about female pelvic organ prolapse-information that usually can only be inferred by means of physical examination. The application of functional radiography to the assessment of defecatory disorders and pelvic organ prolapse has highlighted the limitations of physical examination. It has become clear that pelvic floor disorders rarely occur in isolation and that global pelvic floor assessment is necessary. Despite the advances in other imaging methods, DCP has remained a practical, cost-effective procedure for the evaluation of anorectal and pelvic floor dysfunction. In this article, the authors describe the technique they use when performing DCP, define the radiographic criteria used for diagnosis, and discuss the limitations and clinical utility of DCP.     

Dynamic imaging of the pelvic floor using an open-configuration magnetic resonance scanner

The aims of this study were to develop a noninvasive, erect, gravity-dependent method for assessing movements of the female pelvic floor, to describe the range of movements in pelvic floor ascent and descent in asymptomatic and symptomatic women, and to quantify any differences. A total of 102 women, 28-86 years of age, 35 symptomatic and 67 asymptomatic, were included in the study. They were scanned in a sitting position in an open scanner with good vertical access using fast-gradient echo sequences fast spoiled grass (FSPGR). Measurements of the bladder base, uterocervical junction, and anorectal junction were taken in the sagittal plane. The levator ani (LA) muscle insertion was assessed in the coronal plane with the patients at rest, during maximal strain, and during maximum contraction of the pelvic floor. Premenopausal multiparous women have a significantly lower bladder base (8/0 mm above the baseline; P value = 0.009) and uterocervical junction (15.5/3.5 mm; P value = 0.03) at rest than nulliparous women, and this becomes more apparent on straining. Parity confers a more significant effect on the position and function of the pelvic floor than menopausal status. All pelvic organs are lower at rest and on straining in women with defecation difficulties (0/-24 mm; P value = 0.001). These differences are also seen when comparing women with and without urinary incontinence. Dynamic seated magnetic resonance imaging (MRI) shows that all the pelvic organs are lower at rest and on straining in multiparous women and in those with urinary incontinence than in a group of asymptomatic nulliparous volunteers. This difference is also seen in the position of the bladder base and anorectal junction during pelvic floor contraction. These findings suggest general pelvic floor weakness in women who present with symptoms in one compartment and indicate the need for evaluation of the entire pelvic floor particularly prior to surgery. J. Magn. Reson. Imaging 2001;13:923-929.     

Anatomie und Funktion des Beckenbodens

PELVIC FLOOR: Anatomy of the pelvic floor seemed to be clearly. In opposite the physiology of the Levator ani and the endopelvic fascia is not yet fully understood. Especially the anatomic form of the levator plate does not conform with physiologic concepts. PELVIC STRUCTURES: Pelvic structures can be divided in three groups: the hollow organs, the endopelvic fascia and the muscles. The M. levator ani is the muscle of the pelvic diaphragm. Its parts were given different names (Fig. 1, 4) depending on their function or localization. In anatomic studies the pelvic floor is described as basin-shaped. In contrast to the anatomic results based upon the evaluation of cadavers, dynamic MRI gave different concepts: at rest the levator ani probably has the shape of a dome and differ when contract. The urogenital diaphragm is mostly a fascia and contains only fair muscular components. Therefore, many authors do not accept the term "diaphragm" and the physiologic function is still a matter of discussion. The endopelvic fascia has to fix the organs in the pelvis and forms "streets" for vascular and nervous supply. CONCLUSION: Describing anatomic structures in the common planes (transversal, sagittal, frontal) will help to understand CT- and MRI-imaging.     

MR-based three-dimensional modeling of the normal pelvic floor in women: quantification of muscle mass

OBJECTIVE: Our objective was to use a combination of axial MR source images and three-dimensional (3D) models to describe the anatomy of the normal pelvic floor in young nulliparous women and to measure the volume of the levator ani. SUBJECTS AND METHODS: Ten healthy nulliparous female volunteers (average age, 27 years) underwent T2-weighted MR imaging of the pelvis. Three-dimensional color-coded models of the pelvic bones and organs and the three major components of the levator ani--puborectalis, iliococcygeus, and coccygeus--were created. Source images were used to measure muscle width and signal intensity and to identify ligamentous structures. Using 3D models, we measured the volume of the levator ani, the angle of the levator plate, the posterior urethrovesical angle, and the distance of the bladder neck from the symphysis pubis and the pubococcygeal line. RESULTS: In all volunteers, the signal intensity of the puborectalis exceeded that of the obturator externus. The average volume of the levator ani was 46.6 ml, the average width of the levator hiatus was 41.7 mm, and the average posterior urethrovesical angle was 143.5 degrees. Vaginal shape in the volunteers followed no recognizable pattern. CONCLUSION: Muscle morphology, signal intensity, and volume is relatively uniform among healthy young women.