Abstract: PD02-06
Sources of Funding: None.

Introduction

Dynamic Pelvic Floor Magnetic Resonance Imaging (dMRI) provides objective evaluation of pelvic organ prolapse (POP), and few studies have compared physical examination (PE) to dMRI. We present the largest series comparing dMRI with PE findings._x000D_

Methods

A total of 274 consecutive patients underwent dMRI with defecography, and charts were retrospectively reviewed for Baden-Walker grading of POP (Grade 0-4), absolute dMRI values, and grading by dMRI (Grade 0-3). Exclusion criteria included incomplete PE or dMRI, and males. Clinically significant POP was defined as Baden-Walker (B-W) Grade ≥3 and dMRI Grade ≥2 with clinically insignificant POP defined as B-W Grade 0-1 and dMRI Grade 0. Spearman correlation was performed between absolute dMRI values and POP grade._x000D_

Results

In total, 178 female patients had both PE and dMRI as part of their POP assessment. In the anterior compartment, there was a moderate positive correlation (r=0.652) between dMRI values and PE. PE and dMRI had 90.7% agreement in patients without clinically significant cystocele. Clinically significant cystoceles on PE were read as Grade ≥2 on dMRI in 84.6% of subjects. _x000D_ _x000D_ Correlation between PE and dMRI for apical prolapse was poor (r=0.195). For patients without significant apical prolapse, PE and dMRI had 59.2% agreement. Clinically significant apical prolapse on PE was read as dMRI Grade ≥2 in 62.9% of subjects. However, dMRI detected 30 patients with enterocele with PE agreeing in only 9 patients. Three of these 30 patients (10%) with pure enterocele were misdiagnosed as rectocele on PE. Conversely, PE detected 20 patients with enteroceles with dMRI confirmation in 9 cases. _x000D_ _x000D_ Correlation between PE and dMRI was also poor in the posterior compartment (r=0.277). PE and dMRI had 55.4% agreement in patients without significant posterior prolapse, whereas clinically significant rectoceles were read as dMRI Grade ≥2 in 77.7% of subjects. _x000D_

Conclusions

This is the largest study to date comparing dMRI to PE for the evaluation of POP. dMRI correlated well with PE in the anterior compartment but yielded little additional diagnostic value. Correlation in the posterior compartment was poor, but dMRI tended to agree with PE in higher grades of POP. dMRI was superior to PE in the detection of enterocele and was better able to distinguish enterocele from rectocele. dMRI may add the most diagnostic value in cases where the presence of enterocele is unclear. _x000D_

Funding

None.