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01-09-2015 | Original Article

Can 3D power Doppler identify levator ani vascularization at its pubic insertion?

Authors: Dr. J. Cassadó Garriga, L. Quintas Marques, A. Pessarrodona Isern, E. López Quesada, M. Rodriguez Carballeira, A. Badia Carrasco

Published in: International Urogynecology Journal | Issue 9/2015

Abstract

Introduction and hypothesis

The levator ani is the most important muscle in the pelvic floor. This pilot study using 3D power Doppler aimed to identify normal vascularization of the puborectalis/pubovisceralis muscle at its insertion in nulliparous and premenopausal women.

Methods

Forty nulliparous and premenopausal women were evaluated at the Gynecological Unit of a tertiary hospital. All women underwent a translabial ultrasound (US) with 3D power Doppler. Pubic insertion of the puborectalis/pubovisceralis muscle was assessed in the axial plane, and vascularization index (VI), flow index (FI), and vascularization-flow index (VFI) were calculated bilaterally. Volumes were analyzed offline by two independent observers, and interobserver agreement and correlation between variables was calculated.

Results

A high, statistically significant, correlation was found between the three US indices on each side (p < 0.005). No correlation was found between the US index and either of the demographic parameters of body mass index [(BMI), p > 0.241], or age (p > 0.398). The degree of correlation between the same index on the different sides was not statistically significant.

Conclusion

Puborectalis/pubovisceralis muscle vascularization at its insertion can be identified using 3D Doppler US, but values differ substantially from those of the contralateral side.

Svabik K, Shek KL, Dietz HP (2009) How much does the puborectalis muscle have to stretch during childbirth? BJOG 116:1657–1662CrossRefPubMed

Dietz HP, Moegni F, Shek KL (2012) Diagnosis of levator avulsion injury: a comparison of three methods. Ultrasound Obstet Gynecol 40:693–698CrossRefPubMed

Van Delft K, Schwertner-Tiepelmann N, Thakar R et al (2013) Inter-rater reliability of assessment of levator ani muscle strength and attachment to the pubic bone in nulliparous women. Ultrasound Obstet Gynecol 42:341–346CrossRefPubMed

Shek KL, Dietz HP (2010) Intrapartum risk factors of levator trauma. BJOG 117:1485–1492CrossRefPubMed

Zhuang RR, Song YF, Chen ZQ et al (2011) Levator avulsion using a tomographic ultrasound and magnetic resonance-based model. Am J Obstet Gynecol 205:232.e1–232.e8CrossRef

Notten KJ, Kluivers KB, Fütterer JJ et al (2014) Translabial three-dimensional ultrasonography compared with magnetic resonance imaging in detecting levator ani defects. Obstet Gynecol 124:1190–1197CrossRefPubMed

Vergeldt T, Weemhoff M, Notten KJ et al (2013) Comparison of two scoring systems for diagnosing levator ani muscle damage. Int Urogynecol J Pelvic Floor Dysfunct 24:1501–1506CrossRef

DeLancey JO, Kearney R, Chou Q et al (2003) The appearance of levator ani muscle abnormalities in magnetic resonante images alter vaginal delivery. Obstet Gynecol 101:46–53PubMedCentralCrossRefPubMed

Krofta L, Otcenasek M, Kasikova E et al (2009) Pubococcygeus–puborectalis trauma after forceps delivery: evaluation of the levator ani muscle with 3D/4D ultrasound. Int Urogynecol J Pelvic Floor Dysfunct 20:1175–1181CrossRefPubMed

10.

Cassadó Garriga J, Pessarrodona Isern A, Espuña Pons E et al (2011) Four- dimensional sonographic evaluation of avulsion of the levator ani according to delivery mode. Ultrasound Obstet Gynecol 38:701–706CrossRefPubMed

11.

DeLancey J, Morgan D, Fenner D et al (2007) Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse. Obstet Gynecol 109:295–302CrossRefPubMed

12.

Dietz HP, Simpson JM (2008) Levator trauma is associated with pelvic organ prolapse. BJOG 115:979–984CrossRefPubMed

13.

DeLancey J (2005) The hidden epidemic of pelvic floor dysfunction: achievable goals for improved prevention and treatment. Am J Obstet Gynecol 192:1488–1495CrossRefPubMed

14.

Dietz HP, Steensma AB (2006) The prevalence of major abnormalities of the levator ani in urogynaecological patients. BJOG 113:225–230CrossRefPubMed

15.

Dietz HP, Khullar V (2012) Controversies in urogynecology. IUGA Off Newsl 7(3):8–9, http://c.ymcdn.com/sites/www.iuga.org/resource/resmgr/newsletters/08-2012_

16.

Dietz HP, Bernardo MJ, Kirby A et al (2011) Minimal criteria for the diagnosis of avulsion of the puborectalis muscle by tomographic ultrasound. Int Urogynecol J Pelvic Floor Dysfunct 22:699–704CrossRef

17.

Pairleitner H, Steiner H, Hasenoehrl G et al (1999) Three- dimensional Power Doppler sonography: imaging and quantify- ing blood flow and vascularization. Ultrasound Obstet Gynecol 14:139–143CrossRefPubMed

18.

Jarmy-Di Bella Z, Girao M, Di Bella Junior V et al (2000) Power Doppler of the urethra in continent or incontinent, pre- and postmenopausal women. Int Urogynecol J Pelvic Floor Dysfunct 11:148–155CrossRefPubMed

19.

Siracusano S, Berlotto M, d’Aloia G et al (2001) Colour Doppler ultrasonography og female urethral vascularization in normal young volunteers: a preliminary report. BJU Int 88:378–381CrossRefPubMed

20.

Roll SC, Kutch JJ (2013) Transperineal sonography evaluation of muscles and vascularity in the male pelvic floor. J Diagn Med Sonogr 29:3–10PubMedCentralCrossRefPubMed

21.

Noguti AS, Jarmy-Di Bella ZIK, Oliveira E et al (2008) Ultrasonographic and doppler velocimetric evaluation of the levator ani muscle according to the hormonal status. Eur J Obstet Gynecol Reprod Biol 141:183–185CrossRefPubMed

22.

Oliveira E, Castro RA, Takano CC et al (2007) Ultrasonographic and Doppler velocimetric evaluation of the levator ani muscle in premenopausal women with and without urinary stress incontinence. Eur J Obstet Gynecol Reprod Biol 133:213–217CrossRefPubMed

23.

Liang CC, Chang SD, Chang YL et al (2006) Three-dimensional Power Doppler measurement of perfusion of the periurethral tissue in incontinent women - a preliminary report. Acta Obstet Gynecol Scand 85:608–613CrossRefPubMed

24.

Raine-Fenning NJ, Nordin NM, Ramnarine KV et al (2008) Evaluation of the effect of machine settings on quantitative three-dimensional Power Doppler angiography: an in-vitro flow phantom experiment. Ultrasound Obstet Gynecol 32:551–559CrossRefPubMed

25.

van Delft K, Shobeiri SA, Thakar R et al (2014) Intra- and interobserver reliability of levator ani muscle biometry and avulsion using three-dimensional endovaginal ultrasonography. Ultrasound Obstet Gynecol 43:202–209CrossRefPubMed

26.

Alcazar JL (2008) Three-dimensional Power Doppler derived vascular indices: what are we measuring and how are we doing? Ultrasound Obstet Gynecol 32:485–487CrossRefPubMed

Title: Can 3D power Doppler identify levator ani vascularization at its pubic insertion?
Authors: Dr. J. Cassadó Garriga
L. Quintas Marques
A. Pessarrodona Isern
E. López Quesada
M. Rodriguez Carballeira
A. Badia Carrasco
Publication date: 01-09-2015
Publisher: Springer London
Published in: International Urogynecology Journal / Issue 9/2015
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-015-2689-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Can 3D power Doppler identify levator ani vascularization at its pubic insertion?

Abstract

Introduction and hypothesis

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusion

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