MRI explored for urinary incontinence evaluation: can help in surgical planning.(Gynecology)

CHICAGO -- Magnetic resonance imaging allows for a more accurate and panoramic visualization of female pelvic organ prolapse in the evaluation of urinary stress incontinence than conventional cystourethrography, and could be particularly helpful for surgical planning, according to Dr. Marco Di Girolamo.

MRI allows the clinician to confirm the clinical diagnosis of urinary incontinence, detect concomitant prolapses, and evaluate the grading of organ prolapses. In the future, MRI will replace standard retrograde and micturating cystourethrogram and defecography in the presurgical evaluation of pelvic prolapses, said Dr. Di Girolamo, of Sant' Andrea Hospital, La Sapienza, University of Rome.

Thanks to its panoramic visualization, MRI allows an accurate study of the different components of the pelvic floor, and a dynamic evaluation while the patient is straining or urinating, to assess the degree of pelvic floor relaxation and organ prolapses, he said at the annual meeting of the Radiological Society of North America.

In addition, the modality avoids the risks associated with radiation exposure. There is, however, one problem. At the moment, it's not possible to perform an MRI in the standing position.

Dr. Di Girolamo and colleagues worked around this during dynamic MRI studies by performing T1-weighted spoiled 3D gradient echo acquisitions on the sagittal plane with a sanitary towel placed under the patient during micturition. The 3D images were postprocessed with maximum intensity projection (MIP) algorithms to obtain images similar to voiding cystourethrography.

Static and dynamic MRI studies were performed on 23 women (mean age 62 years) with urinary stress incontinence.

All of the patients were previously studied with a clinical evaluation and underwent urine-flow velocity recording and conventional cystourethrography.