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Role of Static and Dynamic MR Imaging in Surgical Pelvic Floor Dysfunction¹

¹ From the Departments of Radiology (L.B., S.S.R.) and Urology (S.R.), University of California Los Angeles David Geffen School of Medicine, 10833 Le Conte Ave, Los Angeles, CA 90095-1721. Recipient of a Certificate of Merit award for an education exhibit at the 2005 RSNA Annual Meeting. Received June 19, 2007; revision requested July 20; final revision received March 3, 2008; accepted March 5. All authors have no financial relationships to disclose. Address correspondence to L.B. (e-mail: lboyadzhyan{at}mednet.ucla.edu).

Pelvic floor dysfunction (PFD) is a hidden women’s health epidemic in the United States, with over 10% of women having a lifetime risk for undergoing a surgical repair for this problem. Given the paucity of understanding of PFD pathophysiology and the high rate of recurrence and repeat surgery, imaging plays a major role in its clinical management, especially for the preoperative assessment of patients with multicompartment defects and failed surgical repairs. The recent development of fast magnetic resonance (MR) imaging sequences allows noninvasive, radiation-free, rapid, high-resolution evaluation of the entire pelvis in one examination. The H line, M line, organ prolapse (HMO) classification system, which is applied to dynamic MR images, allows consistent standardization and grading of various forms of PFD. In addition, the HMO system clearly defines and differentiates between the two main components of PFD: pelvic floor relaxation and pelvic organ prolapse. In addition to serving as an objective diagnostic tool in patients with surgical PFD, MR imaging has tremendous potential to be used as a research tool in trying to understand the pathophysiology of these complex disorders.

© RSNA, 2008