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Coronal Plane Assessment for Levator Trauma.

Ka Lai Shek¹, Hans Peter Dietz²

¹Liverpool Clinical School, Western Sydney University, Sydney, New South Wales, Australia.

Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine

|May 25, 2024

Summary

Coronal plane ultrasound assessment effectively diagnoses levator trauma, a key cause of pelvic organ prolapse (POP). Muscle mass estimation shows promise for evaluating levator muscle damage in POP patients.

Keywords:

avulsion levator ani pelvic organ prolapse ultrasound

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Area of Science:

Urogynecology
Medical Imaging
Pelvic Floor Disorders

Background:

Levator avulsion is a primary cause of pelvic organ prolapse (POP).
Diagnosis typically relies on tomographic axial plane imaging.
Two-dimensional imaging can visualize the levator muscle.

Purpose of the Study:

To evaluate the reproducibility and validity of coronal plane assessment for diagnosing levator trauma.
To assess levator muscle area and remnant muscle mass using tomographic ultrasound imaging in the coronal plane.

Main Methods:

Retrospective study of women undergoing interview, POPQ, and 4D translabial ultrasound.
Post-processing of archived ultrasound data for coronal plane assessment.
Measurement of levator muscle area and estimation of remnant muscle mass.
Analysis of interobserver reproducibility and association with POP.

Main Results:

Good interobserver agreement for muscle mass estimates (ICC 0.743) and fair for muscle area (ICC 0.482).
Significant association between coronal plane measures (muscle area and mass) and POP.
Coronal plane measures were not superior to the Total Tendon Score (TTS) in predicting POP.

Conclusions:

Coronal plane assessment of ultrasound volume data is a reproducible and valid method for evaluating levator trauma.
Muscle mass estimation may be a more effective measure than muscle area for assessing levator trauma.