MR defaecating proctography

MR defecography is a dynamic study for evaluation of the pelvic floor and pelvic organ prolapse.

Phases

There are four phases of evaluation:

  • rest
  • squeeze
  • strain (Valsalva)
  • defaecation

Method of evaluation

Many variations in the techniques described below exist.

Patient preparation

Typically there is no specific patient preparation required. 

Sequences

Axial, coronal and sagittal T2W sequence images of the pelvis are acquired to assess for structural abnormalities of the pelvic viscera and musculature. 

The dynamic study is carried out by acquiring cine images in the sagittal plane with Tru-Fisp (Siemens) sequence. This is similar to the sequence used for cardiac imaging. The dynamic sequences are acquired during straining, squeezing and evacuation. Prior to the evacuation sequence, 100-150 ml of ultrasound gel is instilled per rectum. Ultrasound gel is used as it is easy to acquire, manipulate into syringes, and is clearly seen on the cine sequences.

Measurements

After the acquisition of the appropriate images, the following lines are drawn and measurements are taken for evaluation and assessment of the outcome of this study.

  • pubococcygeal line - a line joining the inferior aspect of the pubic symphysis to the last coccygeal joint
  • H line - corresponds to the AP diameter of the hiatus
  • M line - is the perpendicular distance between the pubococcygeal line and the posterior anorectal junction
Abnormalities to assess
  • rectal descent
  • bladder base descent (cystocoele)
  • vaginal vault descent
  • rectocoele
  • intussusception
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Article information

rID: 42479
Tag: stub
Synonyms or Alternate Spellings:
  • Dynamic pelvic floor MRI

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Cases and figures

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    This is a cine se...
    Case 1: peritoneocoele
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    Case 2: global pelvic floor descent
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    Case 3: full thickness posterior prolapse
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