MR imaging of levator ani muscle recovery following vaginal delivery

被引:90
作者
Tunn R. [1 ,6 ]
DeLancey J.O.L. [2 ]
Howard D. [2 ]
Thorp J.M. [3 ]
Ashton-Miller J.A. [2 ,4 ]
Quint L.E. [2 ,5 ]
机构
[1] University of Michigan, Ann Arbor, MI
[2] University of North Carolina, Chapel Hill, NC
[3] Dept. Mech. Eng. and Appl. Mechanics, University of Michigan, Ann Arbor, MI
[4] Department of Radiology, University of Michigan, Ann Arbor, MI
[5] Frauenklinik, Campus Mitte, Humboldt-Universität zu Berlin, D-10098 Berlin
关键词
Follow-up in puerperium; Levator ani muscle; MR imaging;
D O I
10.1007/s001929970006
中图分类号
学科分类号
摘要
Our aim was to quantify the changes that occur in the levator ani muscles (LA) after vaginal delivery using magnetic resonance imaging. Fourteen women underwent MRI 1 day postpartum. Six of them were also scanned 1, 2, 6 weeks and 6 months after delivery. LA signal intensities and thickness, in areas of the urogenital and the levator hiatus were assessed in the transverse plane. Perineal body position was measured in the sagittal plane. One day postpartum a higher T2-signal intensity of the LA compared to the obturator internus muscle was found in all women and a lower T1-signal intensity in 8 of 12 women. By 6 months these differences were present in only 1 woman in the left LA. An elevation in perineal body position of 13.4 ± 7.3 mm (P < 0.05), as well as a decrease in the area of the urogenital hiatus by 27% (P < 0.05) and of the levator hiatus by 22% (P < 0.05) by 2 weeks postpartum suggest a return of normal LA geometry. LA thickness showed interindividual variations, and a complete loss of LA tissue was found in 1 woman. Changes in LA signal intensity, topography and thickness during the puerperium can be documented using MR imaging.
引用
收藏
页码:300 / 307
页数:7
相关论文
共 18 条
[1]  
Ivanov A., Tunn R., Luening M., Pfist C., Female pelvic floor and urethra - Normal MR image and anatomic correlations, Radiol Diagnost, 33, pp. 397-405, (1992)
[2]  
Klutke C.G., Siegel C.L., Functional female pelvic anatomy, Urol Clin N Am, 22, 3, pp. 487-498, (1995)
[3]  
Strohbehn K., Ellis J.H., Strohbehn J.A., DeLancey J.O.L., Magnetic resonance imaging of the levator ani with anatomic correlation, Obstet Gynecol, 87, pp. 277-285, (1996)
[4]  
Tan I.L., Stoker J., Zwamborn A.W., Entius K.A., Calame J.J., Lameris J.S., Female pelvic floor: Endovaginal MR imaging of normal anatomy, Radiology, 206, pp. 777-783, (1998)
[5]  
Willms A.B., Brown E.D., Kettritz U.I., Kuller J.A., Semelka R.C., Anatomic changes in the pelvis after uncomplicated vaginal delivery: Evaluation with serial MR imaging, Radiology, 195, pp. 91-94, (1995)
[6]  
Hayats K.S., Thorp J.M., Kuller J.A., Brown B.D., Semelka R.C., Magnetic resonance imaging of the pelvic floor in the postpartum patient, Int Urogynecol J, 7, pp. 321-324, (1996)
[7]  
Bland J.M., Altman D.G., Statistical methods for assessing agreement between two methods of clinical measurements, Lancet, 8, pp. 307-310, (1986)
[8]  
Fleckenstein J.L., Haller R.G., Bertocci L.A., Parkey R.W., Peshock R.M., Glycogenolysis, not perfusion, is the critical mediator of exercise-induced muscle modifications on MR images, Radiology, 183, pp. 25-27, (1992)
[9]  
Fleckenstein J.L., Watumull D., Conner K.E., Et al., Denervated human skeletal muscle: MR imaging evaluation, Radiology, 187, pp. 213-218, (1993)
[10]  
Schedel H., Reimers C.D., Vogl T., Witt T.N., Muscle edema in MR imaging of neuromuscular diseases, Acta Radiol, 36, pp. 228-232, (1995)