Published online before print September 19, 2002, 10.1148/radiol.2252011347
Female Urinary Genuine Stress Incontinence: Anatomic Considerations at MR Imaging of the Paravaginal Fascia and Urethra—Initial Observations1
Nandita M. deSouza, FRCR2,
O. Joseph Daniels, MS,
Andreanna D. Williams, MSc,
David J. Gilderdale, PhD and
Paul D. Abel, FRCS
1 From the Robert Steiner MRI Unit (N.M.d.S., O.J.D., A.D.W., D.J.G.) and Academic Section of Urology in the Department of Surgery (O.J.D., P.D.A.), Faculty of Medicine, Imperial College of Science, Technology and Medicine, Hammersmith Hospital Campus, DuCane Rd, London W12 0HS, England. From the 2001 RSNA scientific assembly. Received August 8, 2001; revision requested September 28; final revision received May 2, 2002; accepted May 14. Supported by Marconi Medical Systems. Address correspondence to N.M.d.S. (e-mail: n.desouza@ic.ac.uk).
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Figure 2a. Quantification of PFV and urethral position. (a) Transverse short inversion time inversion-recovery MR image (2,000/30/107) through the level of the bladder neck shows demarcated regions of interest around the high-signal-intensity fascia anteriorly and laterally. (b, c) Sagittal T2-weighted fast spin-echo (4,000/88 [effective], echo train length of 16) midline MR images. Total UL is measured from bladder neck to level of urethral meatus (arrows). In b, a line from the posterior inferior point of the pubis perpendicular to the long axis of the retropubic urethra demarcates the length of the retropubic urethra. In c, a line from the posterior inferior point of the pubis was drawn through the curved urethra such that the anterior and posterior ULs were equal below the line. A = anterior, P = posterior.
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Figure 2b. Quantification of PFV and urethral position. (a) Transverse short inversion time inversion-recovery MR image (2,000/30/107) through the level of the bladder neck shows demarcated regions of interest around the high-signal-intensity fascia anteriorly and laterally. (b, c) Sagittal T2-weighted fast spin-echo (4,000/88 [effective], echo train length of 16) midline MR images. Total UL is measured from bladder neck to level of urethral meatus (arrows). In b, a line from the posterior inferior point of the pubis perpendicular to the long axis of the retropubic urethra demarcates the length of the retropubic urethra. In c, a line from the posterior inferior point of the pubis was drawn through the curved urethra such that the anterior and posterior ULs were equal below the line. A = anterior, P = posterior.
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Figure 2c. Quantification of PFV and urethral position. (a) Transverse short inversion time inversion-recovery MR image (2,000/30/107) through the level of the bladder neck shows demarcated regions of interest around the high-signal-intensity fascia anteriorly and laterally. (b, c) Sagittal T2-weighted fast spin-echo (4,000/88 [effective], echo train length of 16) midline MR images. Total UL is measured from bladder neck to level of urethral meatus (arrows). In b, a line from the posterior inferior point of the pubis perpendicular to the long axis of the retropubic urethra demarcates the length of the retropubic urethra. In c, a line from the posterior inferior point of the pubis was drawn through the curved urethra such that the anterior and posterior ULs were equal below the line. A = anterior, P = posterior.
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Figure 3a. Distribution of urethral PFV in reference subjects and GSI patients. Transverse short inversion time inversion-recovery MR images (2,000/30/107) through the middle of the urethra in (a, b) two reference subjects and (c) a patient with GSI show the targetlike appearance of the urethra (arrowheads) in cross section. c = coil, r = rectum. The paravaginal fascia (arrows) surrounds the urethra in a and extends laterally around the urethra in b. In c, there is no substantial fascia in relation to the urethra.
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Figure 3b. Distribution of urethral PFV in reference subjects and GSI patients. Transverse short inversion time inversion-recovery MR images (2,000/30/107) through the middle of the urethra in (a, b) two reference subjects and (c) a patient with GSI show the targetlike appearance of the urethra (arrowheads) in cross section. c = coil, r = rectum. The paravaginal fascia (arrows) surrounds the urethra in a and extends laterally around the urethra in b. In c, there is no substantial fascia in relation to the urethra.
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Figure 3c. Distribution of urethral PFV in reference subjects and GSI patients. Transverse short inversion time inversion-recovery MR images (2,000/30/107) through the middle of the urethra in (a, b) two reference subjects and (c) a patient with GSI show the targetlike appearance of the urethra (arrowheads) in cross section. c = coil, r = rectum. The paravaginal fascia (arrows) surrounds the urethra in a and extends laterally around the urethra in b. In c, there is no substantial fascia in relation to the urethra.
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Figure 4. Box plot shows median (middle line of box), quartiles (top and bottom lines of box), upper adjacent value (upper whisker), and lower adjacent value (lower whisker) for urethral PFV (uPFV) in reference subjects compared with GSI patients. Note that the upper adjacent value is equal to the minimum of the (a) upper quartile plus 1.5 times the interquartile range and (b) maximum observation. The lower adjacent value is equal to the maximum of the (a) lower quartile minus 1.5 times the interquartile range and (b) minimum observation.
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Figure 5. Bland-Altman scatterplot for interobserver variability in measurements of urethral PFV. Interobserver differences in urethral PFV plotted against average urethral PFV for observer 1 (Obs1) and observer 2 (Obs2) do not show significant variability.
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Figure 6. Box plot shows median (middle line of box), quartiles (top and bottom lines of box), upper adjacent value (upper whisker), and lower adjacent value (lower whisker) for percentage ratio of retropubic UL to total UL in reference subjects compared with GSI patients. Note that the upper adjacent value is equal to the minimum of the (a) upper quartile plus 1.5 times the interquartile range and (b) maximum observation. Lower adjacent value is equal to the maximum of the (a) lower quartile minus 1.5 times the interquartile range and (b) minimum observation.
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Figure 7a. Sagittal T2-weighted fast spin-echo (4,000/88 [effective], echo train length of 16) midline MR images depict urethral position in (a) a reference subject and (b) a GSI patient. In a, the urethra is virtually entirely retropubic in position. In b, the lower segment of the urethra lies below the pubis. A = anterior, P = posterior, b = bladder, c = coil, r = rectum, s = symphysis pubis. Arrows denote the position of the external urethral meatus.
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Figure 7b. Sagittal T2-weighted fast spin-echo (4,000/88 [effective], echo train length of 16) midline MR images depict urethral position in (a) a reference subject and (b) a GSI patient. In a, the urethra is virtually entirely retropubic in position. In b, the lower segment of the urethra lies below the pubis. A = anterior, P = posterior, b = bladder, c = coil, r = rectum, s = symphysis pubis. Arrows denote the position of the external urethral meatus.
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Copyright © 2002 by the Radiological Society of North America.
