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Dynamic MR Imaging of Pelvic Organ Prolapse: Spectrum of Abnormalities¹

¹ From the Departments of Radiology (H.K.P., D.A.B., E.K.F.), Surgery (H.S.K.), and Gynecology and Obstetrics (G.W.C., R.G.), Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287. Recipient of a Cum Laude award for a scientific exhibit at the 1999 RSNA scientific assembly. Received February 28, 2000; revision requested March 31 and received June 9; accepted June 9. Address correspondence to H.K.P. (e-mail: hpannu@jhmi.edu).

Pelvic organ prolapse is a relatively common condition in women that can have a significant impact on quality of life. Pelvic organ prolapse typically demonstrates multiple abnormalities and may involve the urethra, bladder, vaginal vault, rectum, and small bowel. Patients may present with pain, pressure, urinary and fecal incontinence, constipation, urinary retention, and defecatory dysfunction. Diagnosis is made primarily on the basis of findings at physical pelvic examination. Imaging is useful in patients in whom findings at physical examination are equivocal. Fluoroscopy, ultrasonography, and magnetic resonance (MR) imaging can be useful in evaluating pelvic organ prolapse. Advantages of MR imaging include lack of ionizing radiation, depiction of the soft tissues of the pelvic floor, and multiplanar imaging capability. Dynamic imaging is usually necessary to demonstrate pelvic organ prolapse, which may be obvious only when abdominal pressure is increased. Treatment is more likely to be successful if a survey of the entire pelvis is performed prior to therapy. Therapy is usually undertaken only in symptomatic patients. In all patients, imaging findings must be interpreted in conjunction with physical examination findings and the patient's symptoms.

Index Terms: Pelvic organs, 757.92, 80.92 • Pelvic organs, MR, 757.12141, 83.12141, 85.12141 • Pelvic organs, prolapse, 757.159, 83.143, 85.143

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