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  • Title: Dynamic MRI of the pelvic floor: comparison of performance in supine vs left lateral body position.
    Author: Schawkat K, Pfister B, Parker H, Heinrich H, Barth BK, Weishaupt D, Fox M, Reiner CS.
    Journal: Br J Radiol; 2018 Dec; 91(1092):20180393. PubMed ID: 30160176.
    Abstract:
    OBJECTIVE:: To investigate the performance of MR-defecography (MRD) in lateral body position as an alternative to supine position. METHODS:: 22 consecutive patients (16 females; mean age 51 ± 19.4) with obstructed defecation and 20 healthy volunteers (11 females; mean age 33.4 ± 11.5) underwent MRD in a closed-configuration 3T-MRI in supine and lateral position. MRD included T2 weighted images at rest and during defecation after filling the rectum with 250 ml water-based gel. Measurements were performed in reference to the pubococcygeal line and grade of evacuation was assessed. Image quality (IQ) was rated on a 5-point-scale (5 = excellent). RESULTS:: In patients grades of middle and posterior compartment descent were similar in both body positions (p > 0.05). Grades of anterior compartment descent were significantly higher in lateral position (21/22 vs 17/22 patients with normal or small descent, p < 0.034). In volunteers grades of descent were similar for all compartments in supine and lateral position (p > 0.05). When attempting to defecate in supine position 6/22 (27%) patients showed no evacuation, while in lateral position only 3/22 (14%) were not able to evacuate. IQ in patients was equal at rest (4.4 ± 0.5 and 4.7 ± 0.6, p > 0.05) and slightly better in supine compared to the lateral position during defecation (4.5 ± 0.4 vs 3.9 ± 0.9, p < 0.017). IQ in volunteers was equal in supine and lateral position (p > 0.05). CONCLUSION:: In lateral position, more patients were able to evacuate with similar grades of pelvic floor descent compared to supine position. MRD in lateral position may be a valuable alternative for patients unable to defecate in supine position. ADVANCES IN KNOWLEDGE:: In lateral position, more patients were able to evacuate during MRD. MRD in lateral position may be an alternative for patients unable to defecate in supine position.
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