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European Radiology
Published in: European Radiology 12/2012

Open Access 01-12-2012 | Urogenital

Evaluation of the female pelvic floor in pelvic organ prolapse using 3.0-Tesla diffusion tensor imaging and fibre tractography

Authors: F. M. Zijta, M. M. E. Lakeman, M. Froeling, M. P. van der Paardt, C. S. V. Borstlap, S. Bipat, A. D. Montauban van Swijndregt, G. J. Strijkers, J. P. Roovers, A. J. Nederveen, J. Stoker

Published in: European Radiology | Issue 12/2012

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Abstract

Objectives

To prospectively explore the clinical application of diffusion tensor imaging (DTI) and fibre tractography in evaluating the pelvic floor.

Methods

Ten patients with pelvic organ prolapse, ten with pelvic floor symptoms and ten asymptomatic women were included. A two-dimensional (2D) spin-echo (SE) echo-planar imaging (EPI) sequence of the pelvic floor was acquired. Offline fibre tractography and morphological analysis of pelvic magnetic resonance imaging (MRI) were performed. Inter-rater agreement for quality assessment of fibre tracking results was evaluated using weighted kappa (κ). From agreed tracking results, eigen values (λ1, λ2, λ3), mean diffusivity (MD) and fractional anisotropy (FA) were calculated. MD and FA values were compared using ANOVA. Inter-rater reliability of DTI parameters was interpreted using the intra-class correlation coefficient (ICC).

Results

Substantial inter-rater agreement was found (κ = 0.71 [95% CI 0.63–0.78]). Four anatomical structures were reliably identified. Substantial inter-rater agreement was found for MD and FA (ICC 0.60–0.91). No significant differences between groups were observed for anal sphincter, perineal body and puboperineal muscle. A significant difference in FA was found for internal obturator muscle between the prolapse group and the asymptomatic group (0.27 ± 0.05 vs 0.22 ± 0.03; P = 0.015).

Conclusion

DTI with fibre tractography permits identification of part of the clinically relevant pelvic structures. Overall, no significant differences in DTI parameters were found between groups.

Key Points

• Diffusion tensor MRI offers new insights into female pelvic floor problems.
• DTI allows 3D visualisation and quantification of female pelvic floor anatomy.
• DTI parameters from pelvic floor structures can be reliably determined.
• No significant differences in DTI parameters between groups with/without prolapse.
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Metadata
Title
Evaluation of the female pelvic floor in pelvic organ prolapse using 3.0-Tesla diffusion tensor imaging and fibre tractography
Authors
F. M. Zijta
M. M. E. Lakeman
M. Froeling
M. P. van der Paardt
C. S. V. Borstlap
S. Bipat
A. D. Montauban van Swijndregt
G. J. Strijkers
J. P. Roovers
A. J. Nederveen
J. Stoker
Publication date
01-12-2012
Publisher
Springer-Verlag
Published in
European Radiology / Issue 12/2012
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-012-2548-5

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