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Dynamic MR Imaging of the Pelvic Floor Performed with Patient Sitting in an Open-Magnet Unit versus with Patient Supine in a Closed-Magnet Unit¹

¹ From the Institute of Diagnostic Radiology (K.M.B., J.E.R., K.T., B.M., P.R.H.) and Department of Visceral and Transplant Surgery (F.H.H.), University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland. Received March 26, 2001; revision requested April 25; revision received August 1; accepted September 17. Address correspondence to P.R.H. (e-mail: paul.hilfiker@mri-roentgen.ch).

View larger version (118K): [in a new window]   Figure 1. Rectal contrast agent-enhanced midsagittal T1-weighted 0.5-T open-magnet MR image (23.9/11.3) obtained in a patient sitting at rest. At a separate workstation, descent of the bladder base (white arrow), vaginal vault (black single-headed arrow), and anorectal junction (double-headed arrow) was measured with respect to the inferior pubococcygeal line (line) between the inferior aspect of the symphysis and the last coccygeal joint.

View larger version (145K): [in a new window]   Figure 2a. Midsagittal MR images obtained in a 72-year-old woman with fecal incontinence and a history of hysterectomy. (a) T2-weighted single-shot fast spin-echo MR image (988/29) obtained before rectal contrast agent administration with the patient supine while straining shows bladder base descent (arrow) of 4.5 cm below the pubococcygeal line (line). (b) T1-weighted multiphase spoiled gradient-recalled-echo MR image (14/3) obtained after rectal contrast agent administration with the patient supine while straining shows that the descent of the bladder base is blocked during straining. Note the excellent delineation of the rectoanal wall, which allows identification of a small anterior rectocele (white arrow) and of the descent of the anorectal junction (black arrow) below the pubococcygeal line (line). (c) T1-weighted multiphase spoiled gradient-recalled-echo MR image (22/11) obtained after rectal contrast agent administration with the patient sitting while straining shows a small anterior rectocele (arrow). The line is the pubococcygeal line. (d) T1-weighted multiphase spoiled gradient-recalled-echo MR image (22/11) obtained after rectal contrast agent administration with the patient sitting while defecating shows moderate descent of the bladder base (white arrow) and anorectal junction (black arrow) below the pubococcygeal line (line).

View larger version (162K): [in a new window]   Figure 2b. Midsagittal MR images obtained in a 72-year-old woman with fecal incontinence and a history of hysterectomy. (a) T2-weighted single-shot fast spin-echo MR image (988/29) obtained before rectal contrast agent administration with the patient supine while straining shows bladder base descent (arrow) of 4.5 cm below the pubococcygeal line (line). (b) T1-weighted multiphase spoiled gradient-recalled-echo MR image (14/3) obtained after rectal contrast agent administration with the patient supine while straining shows that the descent of the bladder base is blocked during straining. Note the excellent delineation of the rectoanal wall, which allows identification of a small anterior rectocele (white arrow) and of the descent of the anorectal junction (black arrow) below the pubococcygeal line (line). (c) T1-weighted multiphase spoiled gradient-recalled-echo MR image (22/11) obtained after rectal contrast agent administration with the patient sitting while straining shows a small anterior rectocele (arrow). The line is the pubococcygeal line. (d) T1-weighted multiphase spoiled gradient-recalled-echo MR image (22/11) obtained after rectal contrast agent administration with the patient sitting while defecating shows moderate descent of the bladder base (white arrow) and anorectal junction (black arrow) below the pubococcygeal line (line).

View larger version (139K): [in a new window]   Figure 2c. Midsagittal MR images obtained in a 72-year-old woman with fecal incontinence and a history of hysterectomy. (a) T2-weighted single-shot fast spin-echo MR image (988/29) obtained before rectal contrast agent administration with the patient supine while straining shows bladder base descent (arrow) of 4.5 cm below the pubococcygeal line (line). (b) T1-weighted multiphase spoiled gradient-recalled-echo MR image (14/3) obtained after rectal contrast agent administration with the patient supine while straining shows that the descent of the bladder base is blocked during straining. Note the excellent delineation of the rectoanal wall, which allows identification of a small anterior rectocele (white arrow) and of the descent of the anorectal junction (black arrow) below the pubococcygeal line (line). (c) T1-weighted multiphase spoiled gradient-recalled-echo MR image (22/11) obtained after rectal contrast agent administration with the patient sitting while straining shows a small anterior rectocele (arrow). The line is the pubococcygeal line. (d) T1-weighted multiphase spoiled gradient-recalled-echo MR image (22/11) obtained after rectal contrast agent administration with the patient sitting while defecating shows moderate descent of the bladder base (white arrow) and anorectal junction (black arrow) below the pubococcygeal line (line).

View larger version (143K): [in a new window]   Figure 2d. Midsagittal MR images obtained in a 72-year-old woman with fecal incontinence and a history of hysterectomy. (a) T2-weighted single-shot fast spin-echo MR image (988/29) obtained before rectal contrast agent administration with the patient supine while straining shows bladder base descent (arrow) of 4.5 cm below the pubococcygeal line (line). (b) T1-weighted multiphase spoiled gradient-recalled-echo MR image (14/3) obtained after rectal contrast agent administration with the patient supine while straining shows that the descent of the bladder base is blocked during straining. Note the excellent delineation of the rectoanal wall, which allows identification of a small anterior rectocele (white arrow) and of the descent of the anorectal junction (black arrow) below the pubococcygeal line (line). (c) T1-weighted multiphase spoiled gradient-recalled-echo MR image (22/11) obtained after rectal contrast agent administration with the patient sitting while straining shows a small anterior rectocele (arrow). The line is the pubococcygeal line. (d) T1-weighted multiphase spoiled gradient-recalled-echo MR image (22/11) obtained after rectal contrast agent administration with the patient sitting while defecating shows moderate descent of the bladder base (white arrow) and anorectal junction (black arrow) below the pubococcygeal line (line).

View larger version (119K): [in a new window]   Figure 3a. Midsagittal MR images obtained after hysterectomy in a 45-year-old four-parous woman who had a feeling of a foreign body during defecation. At clinical examination, an anterior rectocele was suspected. (a) On the T2-weighted single-shot fast spin-echo MR image (935/29) obtained before rectal contrast agent administration with the patient supine while straining, an enterocele is not evident. (b) T1-weighted multiphase spoiled gradient-recalled-echo MR image (14.0/2.9) obtained after rectal contrast agent administration with the patient supine while straining shows only a partly stool-filled small anterior rectocele (arrow). (c) T1-weighted multiphase spoiled gradient-recalled-echo MR image (22.5/10.8) obtained after rectal contrast agent administration with the patient sitting while straining shows an anterior rectocele (white arrow) and a moderate hernia of the sigmoid colon (black arrow).

View larger version (146K): [in a new window]   Figure 3b. Midsagittal MR images obtained after hysterectomy in a 45-year-old four-parous woman who had a feeling of a foreign body during defecation. At clinical examination, an anterior rectocele was suspected. (a) On the T2-weighted single-shot fast spin-echo MR image (935/29) obtained before rectal contrast agent administration with the patient supine while straining, an enterocele is not evident. (b) T1-weighted multiphase spoiled gradient-recalled-echo MR image (14.0/2.9) obtained after rectal contrast agent administration with the patient supine while straining shows only a partly stool-filled small anterior rectocele (arrow). (c) T1-weighted multiphase spoiled gradient-recalled-echo MR image (22.5/10.8) obtained after rectal contrast agent administration with the patient sitting while straining shows an anterior rectocele (white arrow) and a moderate hernia of the sigmoid colon (black arrow).

View larger version (149K): [in a new window]   Figure 3c. Midsagittal MR images obtained after hysterectomy in a 45-year-old four-parous woman who had a feeling of a foreign body during defecation. At clinical examination, an anterior rectocele was suspected. (a) On the T2-weighted single-shot fast spin-echo MR image (935/29) obtained before rectal contrast agent administration with the patient supine while straining, an enterocele is not evident. (b) T1-weighted multiphase spoiled gradient-recalled-echo MR image (14.0/2.9) obtained after rectal contrast agent administration with the patient supine while straining shows only a partly stool-filled small anterior rectocele (arrow). (c) T1-weighted multiphase spoiled gradient-recalled-echo MR image (22.5/10.8) obtained after rectal contrast agent administration with the patient sitting while straining shows an anterior rectocele (white arrow) and a moderate hernia of the sigmoid colon (black arrow).

View larger version (117K): [in a new window]   Figure 4a. Midsagittal MR images obtained in a 40-year-old two-parous woman with symptoms of incomplete evacuation. Clinical examination revealed an anterior rectocele. (a) On the T2-weighted single-shot fast spin-echo MR image (1,075.0/30.5) obtained before rectal contrast agent administration with the patient supine while straining, an enterocele is not evident. (b) On the T1-weighted multiphase spoiled gradient-recalled-echo MR image (8.7/2.0) obtained after rectal contrast agent administration with the patient supine while straining, an enterocele is excluded and a moderately sized anterior rectocele (arrow) is seen. (c, d) T1-weighted multiphase spoiled gradient-recalled-echo MR images (22.1/10.6) obtained after rectal contrast agent administration. (c) During straining, a moderately sized anterior rectocele (arrow) is seen. (d) During defecation, an intussusception (white arrows) that caused incomplete evacuation is seen. The moderately sized anterior rectocele (black arrow) also is seen.

View larger version (128K): [in a new window]   Figure 4b. Midsagittal MR images obtained in a 40-year-old two-parous woman with symptoms of incomplete evacuation. Clinical examination revealed an anterior rectocele. (a) On the T2-weighted single-shot fast spin-echo MR image (1,075.0/30.5) obtained before rectal contrast agent administration with the patient supine while straining, an enterocele is not evident. (b) On the T1-weighted multiphase spoiled gradient-recalled-echo MR image (8.7/2.0) obtained after rectal contrast agent administration with the patient supine while straining, an enterocele is excluded and a moderately sized anterior rectocele (arrow) is seen. (c, d) T1-weighted multiphase spoiled gradient-recalled-echo MR images (22.1/10.6) obtained after rectal contrast agent administration. (c) During straining, a moderately sized anterior rectocele (arrow) is seen. (d) During defecation, an intussusception (white arrows) that caused incomplete evacuation is seen. The moderately sized anterior rectocele (black arrow) also is seen.

View larger version (136K): [in a new window]   Figure 4c. Midsagittal MR images obtained in a 40-year-old two-parous woman with symptoms of incomplete evacuation. Clinical examination revealed an anterior rectocele. (a) On the T2-weighted single-shot fast spin-echo MR image (1,075.0/30.5) obtained before rectal contrast agent administration with the patient supine while straining, an enterocele is not evident. (b) On the T1-weighted multiphase spoiled gradient-recalled-echo MR image (8.7/2.0) obtained after rectal contrast agent administration with the patient supine while straining, an enterocele is excluded and a moderately sized anterior rectocele (arrow) is seen. (c, d) T1-weighted multiphase spoiled gradient-recalled-echo MR images (22.1/10.6) obtained after rectal contrast agent administration. (c) During straining, a moderately sized anterior rectocele (arrow) is seen. (d) During defecation, an intussusception (white arrows) that caused incomplete evacuation is seen. The moderately sized anterior rectocele (black arrow) also is seen.

View larger version (156K): [in a new window]   Figure 4d. Midsagittal MR images obtained in a 40-year-old two-parous woman with symptoms of incomplete evacuation. Clinical examination revealed an anterior rectocele. (a) On the T2-weighted single-shot fast spin-echo MR image (1,075.0/30.5) obtained before rectal contrast agent administration with the patient supine while straining, an enterocele is not evident. (b) On the T1-weighted multiphase spoiled gradient-recalled-echo MR image (8.7/2.0) obtained after rectal contrast agent administration with the patient supine while straining, an enterocele is excluded and a moderately sized anterior rectocele (arrow) is seen. (c, d) T1-weighted multiphase spoiled gradient-recalled-echo MR images (22.1/10.6) obtained after rectal contrast agent administration. (c) During straining, a moderately sized anterior rectocele (arrow) is seen. (d) During defecation, an intussusception (white arrows) that caused incomplete evacuation is seen. The moderately sized anterior rectocele (black arrow) also is seen.