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State of the Art |
1 From the Department of Radiology, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 Amsterdam, the Netherlands (J.S.), and the Intestinal Imaging Centre, St Mark’s Hospital, London, England (S.H., C.I.B.). Received June 18, 1999; revision requested August 9; revision received November 9; accepted November 16; updated September 28, 2000. Address correspondence to J.S. (e-mail: j.stoker@amc.uva.nl).
A greater awareness of the therapies now available for pelvic floor dysfunction has increased demand for specialized imaging of this region. Some of the techniques required are available at relatively few centers, and the purpose of this review is to introduce the emerging subspecialty of pelvic floor imaging to a more general readership. Pelvic floor anatomy is complex and is being unraveled by means of magnetic resonance (MR) imaging. This is discussed in detail by using a global, rather than a compartmentalized, anatomic approach. The physiology of normal urinary and anal function and the routine clinical tests applied to them are outlined. The imaging techniques involved include MR imaging, endosonography, and fluoroscopy. The main investigations include video urodynamic imaging, evacuation proctography, dynamic cystoproctography, dynamic MR imaging of the pelvic floor, and endoluminal imaging of the anal sphincters with MR imaging and ultrasonography. These are described in detail, and their role with regard to the main pathologic conditions of the pelvic floor—urinary and anal incontinence, constipation, and prolapse—are discussed.
Index terms: Bladder, abnormalities, 83.832, 83.835 • Colon, abnormalities, 75.133, 75.15, 75.27, 75.73, 75.79, 75.791 • Colon, MR, 75.121411, 75.121412 • Colon, US, 75.12981, 75.12989 • Pelvic organs, 80.11 • Pelvic organs, MR, 80.121411, 80.121412 • Pelvic organs, US, 80.12981, 80.12989 • State of the Art • Urine, incontinence, 82.835
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