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Updated: May 7, 2026
Quantification of Levator Ani Hiatus Enlargement by Magnetic Resonance Imaging in Males and Females with Pelvic Organ Prolapse
Published on: April 17, 2019
Evaluation of pelvic morphology in the sagittal plane
Tomaž Vrtovec1, Michiel M A Janssen, Boštjan Likar
1University of Ljubljana, Faculty of Electrical Engineering, Laboratory of Imaging Technologies, Tržaška cesta 25, SI-1000 Ljubljana, Slovenia.
Background Context:
It is generally accepted that for normal subjects the angle of pelvic incidence (PI) increases during childhood and then remains unchanged throughout adolescence and adulthood. However, recent findings show that PI increases linearly throughout the lifespan due to morphological changes of the pelvis.
Purpose:
A retrospective study aiming to determine the extent of morphological changes of the pelvis related to the age of the subjects.
Study Design:
Pelvic morphology was evaluated in a normal adult population by measuring the anatomical parameters of sagittal pelvic alignment.
Patient Sample:
The final study cohort consisted of 330 subjects (mean age, 45.3 years; standard deviation, 18.1 years; range, 18-87 years; 164 male and 166 female subjects).
Outcome Measures:
Physiologic measures, obtained as measurements of PI, sacral end plate width (S1W), and pelvic thickness (PTH).
Methods:
Parameters of PI, S1W, and PTH were evaluated from computed tomography images of the subjects. The measured PTH was normalized according to S1W and age of the subjects, allowing the comparison among anatomies of different sizes. The normalized components of PTH in anteroposterior and cephalocaudal directions were computed to determine the configuration and extent of changes in pelvic morphology related to subject age.
Results:
Statistically significant correlation with both age and PI was obtained for all normalized parameters (except for the anteroposterior component of PTH for male subjects), and no statistically significant differences were observed between the sexes. With increasing PI that occurs due to the aging process, a decrease of PTH can be observed that is manifested not only as an increase of the distance between the sacrum and the hip axis in the anterior direction but considerably more as a decrease of the distance between the sacrum and the hip axis in the cephalic direction. By considering these morphological changes in the pelvis simultaneously, the hip axis can move only within a narrow area.
Conclusions:
The changes in pelvic morphology due to the aging process occur in the anterior direction, which may be due to the remodeling process affecting the coxal bone that results in an anterior drift of the acetabulum relative to the sacrum. More importantly, the changes are considerably more evident in the cephalic direction, which may be the result of the weight-bearing loads and consequent wear of acetabular cartilage.
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