Podium Session

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PD02-06: DYNAMIC PELVIC MRI IN THE EVALUATION OF PELVIC ORGAN PROLAPSE AND CORRELATION WITH PHYSICAL EXAM FINDINGS

Friday, May 12
7:50 AM - 8:00 AM
Location: BCEC: Room 162

Presentation Authors: Frank C. Lin*, Hina A. Tiwari, Bobby T. Kalb, Joel T. Funk, Christian O. Twiss, Tucson, AZ

Introduction: Dynamic Pelvic Floor Magnetic Resonance Imaging (dMRI) provides objective evaluation of pelvic organ prolapse (POP), and few studies have compared physical examination (PE) to dMRI. We present the largest series comparing dMRI with PE findings.


Methods: A total of 274 consecutive patients underwent dMRI with defecography, and charts were retrospectively reviewed for Baden-Walker grading of POP (Grade 0-4), absolute dMRI values, and grading by dMRI (Grade 0-3). Exclusion criteria included incomplete PE or dMRI, and males. Clinically significant POP was defined as Baden-Walker (B-W) Grade ≥3 and dMRI Grade ≥2 with clinically insignificant POP defined as B-W Grade 0-1 and dMRI Grade 0. Spearman correlation was performed between absolute dMRI values and POP grade.


Results: In total, 178 female patients had both PE and dMRI as part of their POP assessment. In the anterior compartment, there was a moderate positive correlation (r=0.652) between dMRI values and PE. PE and dMRI had 90.7% agreement in patients without clinically significant cystocele. Clinically significant cystoceles on PE were read as Grade ≥2 on dMRI in 84.6% of subjects.

Correlation between PE and dMRI for apical prolapse was poor (r=0.195). For patients without significant apical prolapse, PE and dMRI had 59.2% agreement. Clinically significant apical prolapse on PE was read as dMRI Grade ≥2 in 62.9% of subjects. However, dMRI detected 30 patients with enterocele with PE agreeing in only 9 patients. Three of these 30 patients (10%) with pure enterocele were misdiagnosed as rectocele on PE. Conversely, PE detected 20 patients with enteroceles with dMRI confirmation in 9 cases.

Correlation between PE and dMRI was also poor in the posterior compartment (r=0.277). PE and dMRI had 55.4% agreement in patients without significant posterior prolapse, whereas clinically significant rectoceles were read as dMRI Grade ≥2 in 77.7% of subjects.


Conclusions: This is the largest study to date comparing dMRI to PE for the evaluation of POP. dMRI correlated well with PE in the anterior compartment but yielded little additional diagnostic value. Correlation in the posterior compartment was poor, but dMRI tended to agree with PE in higher grades of POP. dMRI was superior to PE in the detection of enterocele and was better able to distinguish enterocele from rectocele. dMRI may add the most diagnostic value in cases where the presence of enterocele is unclear.


Source Of Funding: None.

Frank C. Lin, MD, MS

University of Arizona

Frank C. Lin, MD, MS is currently a fourth-year urology resident at the University of Arizona - Banner University Medical Center in Tucson, Arizona. He is a graduate of the University of Pennsylvania where he received his B.A. in molecular biology and M.S. in engineering biotechnology. After working at a biotechnology company focused on phage display technology, Dr. Lin returned to his home state of Nebraska for medical school. During his medical studies, he discovered his love of operating and committed to pursue a career in urology with training at the University of Arizona.
Dr. Lin has exceptional basic science and clinical research experience from numerous highly-regarded academic institutions including the National Institutes of Health (NIH), the University of Pennsylvania, and the University of Nebraska Medical Center. He continues to pursue research during his residency at the University of Arizona focusing on all aspects of urologic surgery. His research has been published in peer reviewed journals including the Journal of Virology, International Journal of Oncology, and BMC Urology.
Dr. Lin is anticipated to finish his residency in June 2018 and is pursuing additional fellowship training in Female Pelvic Medicine and Reconstructive Surgery (FPMRS). His career goal is to become an academic urologist focused on providing outstanding patient care, novel urologic research, and excellent resident surgical education.

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PD02-06: DYNAMIC PELVIC MRI IN THE EVALUATION OF PELVIC ORGAN PROLAPSE AND CORRELATION WITH PHYSICAL EXAM FINDINGS



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