Dynamic Pelvic Floor MRI in Pelvic Organ Prolapse: Practical Recommendations for Acquisition and Reporting

Pelvic floor disorders are common and significantly impair women's quality of life. Dynamic pelvic floor magnetic resonance imaging (MRI) has become a key imaging modality for the comprehensive assessment of pelvic organ prolapse (POP), combining morphological and functional evaluation. However, practices remain heterogeneous across centres, with substantial variability in acquisition protocols, reporting terminology and grading systems, which limits comparability and multidisciplinary communication. We hypothesized that a standardized acquisition protocol and structured report, based on a unified clinically oriented semiology, could improve the quality and reproducibility of dynamic pelvic floor MRI.

A multidisciplinary expert panel of radiologists specialized in pelvic floor imaging and gynaecologists with recognized expertise in pelvic floor disorders reviewed the contemporary literature and drafted practical recommendations. Proposals were discussed and refined during dedicated multidisciplinary expert meetings and validated by consensus among participating experts.

A unified terminology-dynamic pelvic floor MRI-is proposed. The recommended protocol comprises a morphological phase and a dynamic phase with repeated straining and defecation manoeuvres. Key quality criteria, indications, limitations and pitfalls are defined. A compartment-based structured report is proposed, using external anatomical landmarks (hymenal plane and anal canal) and a clinically oriented grading system aligned with contemporary prolapse assessment.

A standardized and clinically oriented approach to dynamic pelvic floor MRI acquisition and reporting may improve clinico-radiological correlation and facilitate multidisciplinary management of pelvic organ prolapse.