Standing open magnetic resonance imaging improves detection and staging of pelvic organ prolapse

Authors

  • Lynn Stothers Department of Urologic Sciences, University of British Columbia, Vancouver Canada
  • Jennifer A. Locke University of British Columbia Department of Urologic Sciences
  • Marwa Abdulaziz Stellenbosch Institute for Advanced Study, Wallenberg Research Centre at Stellenbosch University, South Africa
  • Darren Lazare Department of Obstetrics and Gynecology, University of British Columbia
  • Alex Kavanagh Department of Urologic Sciences, University of British Columbia, Vancouver Canada
  • Andrew Macnab Department of Urologic Sciences, University of British Columbia, Vancouver Canada

DOI:

https://doi.org/10.5489/cuaj.7244

Keywords:

Cystocele, Pelvic Reference Lines, POP-Q, Staging, Uterine Prolapse

Abstract

Introduction: The role of imaging in pelvic organ prolapse (POP) assessment is unclear. Open magnetic resonance imaging (MRI) systems have a configuration that allows for imaging women with POP in different positions. Herein, we use a 0.5 Tesla open MRI to obtain supine, seated, and standing images. We then compare these images to evaluate the impact of posture on detection and staging of POP.

Methods: Women presenting with symptoms of POP at a tertiary care university hospital were asked to participate in this prospective cohort study. Symptom scores, POP-Q staging and three-position MRI imaging of the pelvis data were collected. The pubococcygeal line (PCL) was used to quantify within-patient changes in pelvic organ position as defined by: no displacement, <1 cm inferior to the PCL, mild (1–3 cm), moderate (3.1–6 cm), and severe (>6 cm) in the axial and sagittal T2-weighted images. Statistical analysis was completed (T-test; p<0.05 significant).

Results: A total of 42 women, age range 40–78 years, participated. There was a significant difference in the mean values associated with anterior prolapse in the supine (0.7±1.8), seated (2.4±3.4), and upright (4.2±1.6) positions (p=0.015). There was a significant difference in the mean values associated with apical prolapse in the supine (0.5±1.5), seated (1.5±1.4), and upright (2.1±1.5) positions (p=0.036).

Conclusions: Our findings suggest that POP is more readily detected and upstaged with standing MRI images as compared to supine and seated positions. The developed two-minute standing MRI protocol may enable clinicians to better assess the extent of POP.

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Author Biography

Jennifer A. Locke, University of British Columbia Department of Urologic Sciences

Resident

Published

2021-08-26

How to Cite

Stothers, L., Locke, J. A., Abdulaziz, M., Lazare, D., Kavanagh, A., & Macnab, A. (2021). Standing open magnetic resonance imaging improves detection and staging of pelvic organ prolapse. Canadian Urological Association Journal, 16(1), E20–4. https://doi.org/10.5489/cuaj.7244

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Section

Original Research