Kinematics of the Uterus: Cine Mode MR Imaging

Movie 1. Uterine prolapse in a 55-year-old woman. Kinematic HASTE MR images were obtained both at rest and during the Valsalva maneuver. The images obtained at rest show a normal appearance of the pelvic organs and floor. However, images obtained during three Valsalva maneuvers demonstrate severe uterine and bladder prolapse.

Movie 2. Cystocele in a 57-year-old woman. Kinematic HASTE MR images were obtained both at rest and during the Valsalva maneuver. The images obtained at rest show generalized pelvic floor descent. Images obtained during three Valsalva maneuvers show the development of an isolated severe descent of the bladder and vaginal vault prolapse.

Movie 3. Normal respiratory movement of the pelvic organs and peristalsis of the small intestine in a 27-year-old woman. Kinematic MR images obtained over 2 minutes during quiet respiration (15 respiratory cycles) show fine respiratory movement of the pelvic organs in the craniocaudal direction and peristalsis of the intestinal loop. These findings indicate no adhesions of the adjacent organs in the pelvis.

Movie 4. Confirmed adhesions between the uterus and loops of the small intestine and closure of the Douglas pouch due to endometriosis in a 23-year-old woman. Kinematic MR images obtained over 2 minutes during quiet respiration (23 respiratory cycles) show that fine respiratory movement of the pelvic organs, defined as movements of less than 1 cm in the craniocaudal direction with respiration, is reduced (cf, Movie 3). This finding may suggest that the uterus adheres to the Douglas pouch. The intestinal loop adjacent to the anterior wall of the uterus lacks peristalsis focally and lacks the sliding fine movement relative to the anterior wall of the uterus (arrow), indicating adhesion to the uterus, in contrast to other intestinal loops that show active peristalsis (arrowhead).

Movie 5. Confirmed adhesions between the uterus and endometrial cyst and closure of the Douglas pouch due to endometriosis in a 39-year-old woman. Kinematic MR images obtained over 2 minutes during quiet respiration (21 respiratory cycles) show reduced fine respiratory movement of the posterior aspect of the uterus and ovary, indicating fixation to the Douglas pouch (cf, Movie 3). However, peristalsis and the sliding fine movement between the anterior wall of the uterus and intestinal loops is seen as normal, indicating no intestinal adhesions (intestinal loops were confirmed to be adhesion free).

Movie 6. Sustained uterine contraction in a 23-year-old healthy volunteer. Kinematic HASTE images obtained over 2 minutes during quiet respiration (20 respiratory cycles) show a course of changes in configuration and signal intensity within the myometrium, which start as a small focus and enlarge to a nodular mass of low signal intensity that distorts the endometrium.


a.	b.

Movie 7. Schema of uterine peristalsis. (a) Wave conduction in the inner myometrium associated with an endometrial stripping movement. Typical wave conduction is seen in the inner layer of the myometrium. The wave conducts along a longitudinal axis (in the cervicofundal or fundocervical direction) and is associated with the endometrial stripping movement. (b) The wave motion is identifiable as an endometrial stripping movement along the short axis only; there is no perceptible conduction of wave along the longitudinal axis. White area: endometrium. Gray area: outer myometrium. Black area: inner myometrium (junctional zone).


a.	b.

Movie 8. (a) Transvaginal US in a 33-year-old healthy volunteer obtained over 2 minutes shows the endometrial stripping movement with a frequency of six times per 2 minutes. (b) Kinematic MR images in the same volunteer obtained over 2 minutes during quiet respiration (20 respiratory cycles) show the cervicofundal conduction of subendometrial low signal intensity, which is clearly identifiable in association with the endometrial stripping movement, with a frequency of six times per 2 minutes. The frequency and direction of peristalsis is the same as seen with transvaginal US.


a.	b.	c.

Movie 9. Lack of diurnal change in peristalsis in a 26-year-old healthy volunteer is demonstrated by kinematic MR images obtained over 2 minutes during quiet respiration at four time points during the same day: (a) At 8 AM, conduction of low signal intensity is cervicofundal and is associated with a prominent endometrial stripping movement, with a frequency of six times per 2 minutes (23 respiratory cycles). (b) At 6 PM, conduction of low intensity is cervicofundal and is associated with a prominent endometrial stripping movement, with a frequency of seven times per 2 minutes (19 respiratory cycles). (c) At 11 PM, conduction of low intensity is cervicofundal and is associated with a prominent endometrial stripping movement, with a frequency of six times per 2 minutes (23 respiratory cycles).


a.	b.	c.

Movie 10. Kinematic MR images obtained over 2 minutes during quiet respiration in a 26-year-old healthy volunteer during three menstrual cycle phases. (a) In the periovulatory phase, conduction of low signal intensity is cervicofundal and is associated with a prominent endometial stripping movement, with a frequency of seven times per 2 minutes (20 respiratory cycles). (b) In the luteal phase, the endometrial configuration is stable, without obvious conduction of low intensity (19 respiratory cycles). (c) In the menstrual phase, conduction of low intensity is fundocervical, with a frequency of four times per 2 minutes (21 respiratory cycles). The endometrial configuration is distorted, squeezed around the fundus to appear rounded or pointed.


a.	b.

Movie 11. (a) Kinematic MR images obtained over 2 minutes during quiet respiration (21 respiratory cycles) in a 32-year-old healthy volunteer without use of an anticholinergic agent. The conduction of low signal intensity in the uterus is cervicofundal and is associated with an obvious endometial stripping movement, with a frequency of four times per 2 minutes. Peristalsis of the intestinal loop is also clearly identifiable. (b) Kinematic MR images obtained over 2 minutes during quiet respiration (21 respiratory cycles) in the same volunteer with use of an anticholinergic agent show not only the peristalsis of the intestinal loop but that uterine contraction has been suppressed. A small leiomyoma in the anterior wall of the uterus is seen.


a.	b.

Movie 12. (a) Kinematic MR images obtained over 2 minutes during quiet respiration (18 respiratory cycles) in a 29-year-old healthy volunteer without ingestion of an oral contraceptive. To-and-fro conduction of low signal intensity in the uterus is seen and is associated with an endometial stripping movement, with a frequency of six times per 2 minutes. (b) Kinematic MR images obtained over 2 minutes during quiet respiration (13 respiratory cycles) in the same volunteer with ingestion of an oral contraceptive. Uterine contraction is not perceptible, nor is uterine peristalsis clearly identifiable.

Movie 13. Confirmed endometrial carcinoma (stage Ib) in a 79-year-old woman. Kinematic MR images obtained over 2 minutes during quiet respiration (21 respiratory cycles) show obvious to-and-fro conduction of subendometrial low signal intensity at the anterior wall of the uterus and is associated with an endometrial stripping movement, with a frequency of six times per 2 minutes. However, conduction of subendometrial low intensity is focally disrupted at the site of the tumor, and the endometrial stripping movement appears to be more irregular near the tumor. These findings on kinematic images may be a clue that indicates myometrial invasion. Invasion of less than the inner half of the myometrium was confirmed at surgery in this case.

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