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DOI: 10.1055/s-2003-40921
© Georg Thieme Verlag Stuttgart · New York
Funktionelle Magnetresonanztomographie (MRT) des Beckenbodens: Postpartale Veränderungen bei Erstgebärenden nach vaginaler Spontangeburt
Functional MRI of the Pelvic Floor: Postpartum Changes of Primiparous Women after Spontaneous Vaginal DeliveryPublication History
Publication Date:
29 July 2003 (online)
Zusammenfassung
Ziel: Darstellung von morphologischen und funktionellen Veränderungen am Beckenboden bei Erstgebärenden nach spontanvaginaler Entbindung mittels funktioneller MRT. Methodik: Funktionelle MRT des Beckenbodens von 26 Erstgebärenden nach vaginaler Entbindung im Vergleich zu 41 Frauen, die noch nicht geboren hatten. Bestimmung morphometrischer Parameter (Muskeldicken, Beckenkonfiguration) und quantitative Erfassung der Lageveränderungen der Beckenorgane beim Pressversuch anhand von Referenzlinien. Ergebnisse: Das Beckenskelett war bei beiden Gruppen gleich konfiguriert. Der M. puborectalis war in der Erstgebärenden-Gruppe signifikant ausgedünnt. Im funktionellen Untersuchungsteil fanden sich in Ruhe keine wesentlichen Unterschiede zwischen beiden Kollektiven. Erst beim Pressversuch zeigte sich eine signifikant größere Häufigkeit von Zystozelen, Rektozelen und Rektumdeszensus bei den Erstgebärenden. Schlussfolgerung: Um das Zusammenspiel der Beckenorgane hinsichtlich eines Organdeszensus zu beurteilen, ist eine dynamische Untersuchung erforderlich. Die funktionelle MRT des Beckenbodens ist ohne Strahlen- oder Kontrastmittelbelastung hervorragend geeignet, die signifikanten Veränderungen am Beckenboden nach vaginaler Geburt aufzuzeigen.
Abstract
Purpose: Detection of morphological and functional changes of the pelvic floor with functional MRI in primiparous women after spontaneous vaginal delivery. Methods and Materials: The study comprises 26 primiparous women after vaginal delivery and a control group of 41 healthy asymptomatic nulliparous volunteers. MRI was performed on a 1.5 T system in supine position with vagina and rectum opacified with Sonogel. The static images consisted of sagittal and axial T2-weighted SE sequences and functional images of true FISP sequences in midsagittal and axial planes acquired with the patient at rest, straining and during defecation. Evaluation of morphometric parameters included pelvimetry, thickness of the puborectal muscle and width of the urogenital hiatus as well as position and movement of the pelvic organs relative to the pubococcygeal reference line. Results: The configuration of the bony pelvis did not differ for both groups. The puborectal muscle was significantly thinner in the study group (0.8 cm vs 0.6 cm). The functional images showed no significant differences between both groups at rest but a significantly increased incidence in the descent of the bladder neck, vaginal fornix and anorectal junction in the study group during straining. In addition, the primiparous women had more prominent rectoceles (0.6 cm vs 1.5 cm). Conclusion: Static imaging alone fails to demonstrate relevant pelvic floor changes and a functional method is necessary to evaluate the interactions of the pelvic organs regarding organ descent. Functional MRI of the pelvic floor is an excellent method to reveal the significant changes of the pelvic floor after vaginal birth without exposing the uterus to radiation.
Key words
Magnetic resonance (MR), cine study - pelvic organs, MR - pelvic organs, prolapse - pelvic organs, abnormalities - pelvic organs, postpartum changes
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Dr. Andreas Lienemann
Institut für Klinische Radiologie, Klinikum der LMU München - Innenstadt
Ziemssenstraße 1
80336 München
Phone: + 49-89-5160-0
Email: andreaslienemann@web.de