Three-dimensional magnetic resonance imaging assessment of levator ani morphologic features in different grades of prolapse
Abstract
Objective The study was undertaken to identify the morphologic changes in the levator ani in different grades of prolapse by using reconstructed three-dimensional models of magnetic resonance images (MRI) and to subclassify prolapse into different categories on the basis of their levator ani morphologic characteristics.Study design Sixty-one women were studied, 8 women in stage I, 15 women in stage II, 22 women in stage III, 7 women in stage IV prolapse, and 9 asymptomatic volunteers with stage 0 prolapse. Axial, sagittal, and coronal T2-weighted pelvic magnetic resonance scans were obtained with the patient in the supine position. The three-dimensional models were reconstructed from the source images by using manual segmentation and surface modeling. The morphologic characteristics of the puborectalis were assessed on these reconstructed models by measuring (1). the levator symphysis gap, (2). the width of the levator hiatus, and (3). the length of the levator hiatus. To assess the iliococcygeus, we measured (1). the maximum width of the iliococcygeus, (2). the direction of its fibers that was assessed by measuring the iliococcygeal angle, and (3) the levator plate angle. Nine nulliparous asymptomatic women were studied as controls.Results Alterations in levator ani morphologic features are not dependent on the grade of the prolapse, and not all women with pelvic floor prolapse have abnormal morphologic features. In healthy control subjects, the iliococcygeal width measured less than 40 mm and the iliococcygeal angle measured less than 20 degrees. On the basis of the MRI findings, four patterns of changes in the levator ani have been identified. Both the levator symphysis gap and the levator hiatus, which is dependent on the puborectalis function, widen with increasing grade of prolapse.Conclusion It is possible to subclassify prolapse on the basis of morphologic changes in the levator ani by using MRI. This may be a very useful predictor as to which patients have recurrent prolapse develop after surgery.
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Women with POP have pelvic floor muscle impairment.
“Women with POP have shown to have PFM impairment [4, 6, 8–16]”
From International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training (2022) · cites this paper as [11]
The association between a decrease in levator plate angle, an increase in levator hiatus area and presence of POP has been confirmed in several studies.
“The association between a decrease in levator plate angle, increase in levator hiatus area and presence of POP has been confirmed in several studies [5–13].”
From International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training (2022) · cites this paper as [11]
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- Authors
- Singh, K., Jakab, M., Reid, W. M. N., Berger, L. A., & Hoyte, L.
- Affiliations
- The Royal Free Hospital (GB)
- Brigham and Women's Hospital (US)
- ORCID
- Reid, Wendy M.N.
- Venue
- American Journal of Obstetrics and Gynecology
- Publisher
- Elsevier BV
- Published
- 2003-04
- Volume
- 188
- Issue
- 4
- Pages
- 910-915
- ISSN
- 0002-9378 (ISSN-L)
- OpenAlex
- W1987673449
- Cited by
- 139
- References
- 20
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 3 · 2023: 1 · 2022: 9 · 2021: 3 · 2020: 4 · 2019: 2 · 2018: 5 · 2017: 5 · 2016: 6 · 2015: 13 · 2014: 5 · 2013: 5 · 2012: 2
- FWCI
- 4.26
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
- Health Sciences › Medicine › Surgery › Hernia repair and management
- Keywords
- pelvic floor prolapse, levator ani muscle, puborectalis, levator hiatus
- MeSH terms
- Female, Humans, Magnetic Resonance Imaging, Reference Values, Severity of Illness Index, Uterine Prolapse, Pelvic Floor, Imaging, Three-Dimensional
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