Evaluation of pelvic adhesions using multiphase and multislice MR imaging with kinematic display

The purpose of this study was to evaluate whether kinematic multiphase and multislice MR imaging could reveal pelvic adhesions.

Before surgery, 52 women with gynecologic disorders underwent half-Fourier acquisition single-shot fast spin-echo imaging with multiphase and multislice acquisitions. Images were displayed in a cine mode, and the motion of each organ against adjacent organs was evaluated by two radiologists who were unaware of the patients' histories or of the findings of their clinical examinations or surgeries. Findings from MR imaging were classified into three types relative to the adjacent organs: type 1, sliding, defined as organs moving 1 cm or more; type 2, fine motion, defined as organs moving less than 1 cm; or type 3, no motion. Type 2 was further subdivided into two groups: type 2-A, independent fine movement, and type 2-B, synchronous fine movement. All MR imaging findings were verified by laparotomy or laparoscopy. Peristalsis at the rectum, colon, and small intestine were also evaluated.

A total of 317 interfaces were evaluated. For findings of type 1 (n = 8 interfaces) and type 2-A (n = 245) on kinematic MR imaging, the negative predictive values for adhesions were 100% and 95.5%, respectively. Findings of type 2-B (n = 52) and type 3 (n = 12) with no adhesions were observed in 40.4% and 66.7%, respectively. When type 1 and type 2-A were regarded as negative findings of adhesions, and type 2-B and type 3 as positive, sensitivity, specificity, and accuracy were 72.5%, 87.4%, and 85.4%, respectively. Peristalsis was observed in 69.2% of patients at the rectum, 86.5% at the colon, and 100% at the small intestine.

Multiphase and multislice MR imaging with kinematic display may provide new information about the presence of pelvic adhesions.