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Published on: April 17, 2019
[Dynamic magnetic resonance imaging of the pelvic floor: Technical aspects]
1Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland. christopher.kaempfer@ukbonn.de.
Background:
Dynamic magnetic resonance imaging (MRI) of the pelvic floor plays a key role in imaging complex pelvic floor dysfunction. High-quality examination is crucial for diagnostic benefit but can be technically challenging.
Objectives:
The most important technical aspects (patient selection, patient preparation, MRI technology, MRI scan protocol, success control) for obtaining a state-of-the-art dynamic MRI of the pelvic floor are summarized.
Materials And Methods:
Review of the scientific literature on dynamic pelvic MR imaging with special consideration of the joint recommendations provided by the expert panels of European Society of Urogenital Radiology/European Society of Gastrointestinal and Abdominal Radiology (ESUR/ESGAR) in 2016 and Society of Abdominal Radiology (SAR) in 2019.
Results:
Examination with at least 1.5 T and a surface coil after rectal instillation of ultrasound gel is clinical standard. Dynamic MRI in a closed magnet with the patient in supine position is the most widespread technique. No clinically significant pathologies of the pelvic floor are missed compared to the sitting position in an open magnet. The minimum scan protocol should encompass static, high-resolution T2-imaging (i.e., T2-TSE) in three planes and dynamic sequences with high temporal resolution in sagittal (and possibly axial) plane (i.e., steady-state or balanced steady-state free precession) during squeezing, straining and evacuation. Detailed patient instruction and practicing prior to the scan improve patients' compliance and hence diagnostic quality.
Conclusions:
A technically flawless dynamic MRI of the pelvic floor according to these standards can provide information missed by other imaging modalities and hence alter therapeutic strategies.
Insights
Dynamic pelvic floor MRI provides crucial diagnostic information for complex dysfunction. Adhering to standardized technical protocols ensures high-quality imaging and can alter patient treatment strategies.
Area of Science:
- Radiology
- Medical Imaging
- Pelvic Floor Disorders
Context:
- Dynamic magnetic resonance imaging (MRI) is essential for evaluating complex pelvic floor dysfunction.
- Achieving high-quality dynamic pelvic MRI is technically challenging but critical for accurate diagnosis.
Purpose:
- To summarize key technical aspects for state-of-the-art dynamic pelvic MRI.
- To provide guidance on patient selection, preparation, MRI technology, protocols, and quality control.
Summary:
- Standard protocols involve 1.5T MRI with surface coils and rectal gel instillation.
- Dynamic MRI in a closed, supine magnet is preferred, with static T2-imaging and dynamic sequences during pelvic floor actions.
- Thorough patient instruction and practice enhance compliance and diagnostic quality.
Impact:
- Technically sound dynamic pelvic MRI offers unique diagnostic insights.
- This advanced imaging can significantly influence therapeutic strategies for pelvic floor disorders.
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