A preliminary application of tomographic ultrasound imaging and magnetic resonance imaging in evaluating levtor avulsion in postpartum women

doi:10.3877/cma.j.issn.1672-6448.2018.10.013

Abstract

Abstract:

Objective

To study the changes of levator-urethra gap (LUG) by tomographic ultrasound imaging (TUI) and levator-symphysis gap (LSG) by magnetic resonance imaging (MRI) in postpartum females.

Methods

Twenty postpartum women with levator avulsion and 20 nulliparas were examined by TUI and LUGs were measured on the slice 0,1 and 2. Magnetic resonance imaging scans of levator ani muscle were obtained in thin slices. Then a three-dimensional model of the levator ani muscle was created by Mimics software. LSGs were measured on three-dimensional models.

Results

None levator avulsion were found in the images of 20 nulliparas. LUG was (17.80±1.39) mm and LSG was (19.71±1.94) mm. The levator avulsions were found in 28 sides, and 12 sides were without levator avulsion. The LUG of levator avulsion (27.94±2.53) mm was greater than that of intact levator ani muscle (19.78±1.35) mm, and the difference was statistically significant (t=8.352, P<0.05). The LSG of levator avulsion (37.39±4.11) mm was greater than that of intact levator ani muscle (21.81±2.96) mm, and the difference was statistically significant (t=8.352, P<0.05).

Conclusions

TUI and MRI are effective examinations to diagnose levator avulsion. LUG and LSG are good imaging parameters to evaluate the levator avulsion in postpartum women.

Key words: Ultrasonography, Magnetic resonance imaging, Levator-urethra gap, Levator-symphysis gap

Yulin Yan, Chaoran Dou, Qin Li, Yan Xi, Xia Wang, Bing Hu, Tao Ying. A preliminary application of tomographic ultrasound imaging and magnetic resonance imaging in evaluating levtor avulsion in postpartum women[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2018, 15(10): 790-795.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2018.10.013

https://chaosheng.cma-cmc.com.cn/EN/Y2018/V15/I10/790

Figures/Tables 6

References 15

1	Trutnovsky G, Kamisan Atan I, Ulrich D, et al Levator ani trauma and pelvic organ prolapse-a comparison of three translabial ultrasound scoring systems [J]. Acta Obstet Gynecol Scand, 2016, 95(2): 1411-1417.
2	Caudwell-Hall J, Kamisan Atan I, Martin A, et al. Intrapartum predictors of maternal levator ani injury [J]. Acta Obstet Gynecol Scand, 2017, 96(4): 426-431.
3	Dietz HP, Lanzarone V. Levator trauma after vaginal delivery [J]. Obstet Gynecol, 2005, 106(4): 707-712.
4	DeLancey JO, Kearney R, Chou Q, et al. The apperance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery [J]. Obstet Gynecol, 2003, 101(1): 46-53.
5	Volløyhaug I, Mørkved S, Salvesen KÅ. Association between pelvic floor muscle trauma and pelvic organ prolapse 20 years after delivery [J]. Int Urogynecol J, 2016, 27(1): 39-45.
6	Dietz H, Simpson J. Levator trauma is associated with pelvic organ prolapse [J]. BJOG, 2008, 115(8): 979-984.
7	刘菲菲，徐莲，应涛, 等. 三维超声观察分娩期间肛提肌损伤的初步应用 [J]. 中国超声医学杂志, 2014, 30(1): 61-63.
8	Ashton-Miller JA, Delancey JO. On the Biomechanics of Vaginal Birth and Common Sequelae [J]. Annu Rev Biomed Eng, 2009, 11: 163-176.
9	Kruger JA1, Dietz HP, Budgett SC, et al. Comparison between transperineal ultrasound and digital detection of levator ani trauma. Can we improve the odds? [J]. Neurourol Urodyn, 2014, 33(3): 307-311.
10	Lin FC, Funk JT, Tiwari HA, et al. Dynamic Pelvic MRI Evaluation of Pelvic Organ Prolapse Compared to Physical Exam Findings [J]. Urology, 2018. pii: S0090-4295(18)30551-X.
11	Shi M, Shang S, Xie B, et al. MRI changes of pelvic floor and pubic bone observed in primiparous women after childbirth by normal vaginal delivery [J]. Arch Gynecol Obstet, 294(2): 285-289.
12	Dietz HP, Bernardo MJ, Kirby A, et al. Minima criteria for the diagnosis of avulsion of the puborectalis muscle by tomographic ultrasound [J]. Int Urogynecol J, 22(6): 699-704.
13	Dietz HP, Garnham AP, Rojas RG. Is the levator urethra gap helpful for diagnosing avulsion? [J]. Int Urogynecol J, 2016, 27(6): 909-913.
14	Kamisan Atan I, Shek KL, Furtado GI, et al. The Association Between Levator-Urethra Gap Measurements and Symptoms and Signs of Female Pelvic Organ Prolapse [J]. Female Pelvic Med Reconstr Surg, 2016, 22(6): 442-446.
15	Zhuang RR, Song YF, Chen ZQ, et al. Levator avulsion using a tomographic ultrasound and magnetic resonance–based model [J]. Am J Obstet Gynecol, 2011, 205(3): 232.e1-e8.

组别		例数	LUG	LSG
未育组		40	17.80±1.34	19.71±1.94
产后组		?	?	?
?	肛提肌撕脱侧	28	27.94±2.53^a	37.39±4.11^a
?	肛提肌无撕脱侧	12	19.78±1.35^bc	21.81±2.96^bc
F值		?	82.54	140.20
P值		?	<0.0001	<0.0001

组别		例数	LUG	LSG
未育组		40	17.80±1.34	19.71±1.94
产后组		?	?	?
?	肛提肌撕脱侧	28	27.94±2.53^a	37.39±4.11^a
?	肛提肌无撕脱侧	12	19.78±1.35^bc	21.81±2.96^bc
F值		?	82.54	140.20
P值		?	<0.0001	<0.0001

[1]	Shujie Wei, Pinjing Hui, Yafang Ding, Bai Zhang, Yanhong Yan, Peng Zhou, Yabo Huang. Evaluation of cerebral hemodynamics in patients with unilateral internal carotid artery occlusion undergoing superficial temporal artery-middle cerebral artery bypass [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1046-1055.
[2]	Xuan Zhang, Yutong Ma, Yuqian Miao, Yun Zhang, Shiwen Wu, Xiaochu Dang, Yingying Chen, Zhaoming Zhong, Xuejuan Wang, Miao Hu, Yanfeng Sun, Xiuzhu Ma, Faqin Lyu, Haiyan Kou. Ultrasound assessment of diaphragm function in pediatric patients with Duchenne muscular dystrophy [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1068-1073.
[3]	Lianhua Zhu, Xiang Fei, Peng Han, Bo Jiang, Nan Li, Yukun Luo. Value of high frame rate contrast-enhanced ultrasound in differential diagnosis of gallbladder polyp lesions [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 904-910.
[4]	Meifang Zhang, Ying Tan, Qiaozhen Zhu, Xin Wen, Ying Yuan, Yue Qin, Hongbo Guo, Lingxiu Hou, Wenlan Huang, Guiyan Peng, Shengli Li. Artificial intelligence-based quality control of mid-sagittal plane ultrasound images for first trimester fetal crown-rump length [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 945-950.
[5]	Ruina Zhao, Yuxin Jiang, Tao Chen, Li Zhang, Cheng Chen, Siqi Jin, Xueqi Chen, Xiao Yang, Jianchu Li. Present status and reform demands of continuing medical education for ultrasonic physicians in Beijing [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 966-973.
[6]	Yuhan Zhou, Huan Xiao, Chunjiang Yang, Juan Zhou, Lirong Zhu, Juan Xu, Fangting Mou. Diagnostic value of ultrasound in children with temporary hip synovitis [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 795-800.
[7]	Huanyan Liu, Yang Hua, Lingyun Jia, Xinyu Zhao, Beibei Liu. Lumen structure and hemodynamic characteristics of occluded internal carotid artery [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 809-815.
[8]	Lianlian Zhang, Pinjing Hui, Yafang Ding. Clinical value of carotid Doppler ultrasonography in assessing vulnerability of atherosclerotic plaques [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 816-821.
[9]	Yaping Jia, Shu'e Zeng. Ultrasound and pathological characteristics of breast metaplastic carcinoma containing squamous cell carcinoma components [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 844-848.
[10]	Gang Luo, Silin Pan, Taotao Chen, Qian Xu, Zhixian Ji, Sibao Wang, Lingyu Sun. Application of echocardiography in fetal cardiac intervention of pulmonary atresia with intact ventricular septum [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(06): 605-609.
[11]	Jia Huang, Hua Shi, Yuguo Zhang, Jiaqi Hu, Qian Chen. Ultrasonographic features of normal and abnormal fetal left brachiocephalic vein and their clinical significance [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(06): 610-617.
[12]	Ze Yuan, Li Zhuang. Value of ultrasound detection of fetal umbilical artery and middle cerebral artery blood flow in diagnosis of fetal intrauterine distress [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(06): 618-621.
[13]	Jiachun Jiang, Xiaobing Wang, Peirong Chen, Shihao Xu. Clinical value of serological indicators combined with conventional ultrasound and contrast-enhanced ultrasound scoring in diagnosis of primary Sjögren's syndrome [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(06): 622-630.
[14]	Zhuangzhuang Wu, Xiaojuan Zhang, Zehong Shi, yao Shi, Shaoling Yuan. Prognostic value of ultrasound combined with mammography and PR and HER-2 status in high-grade and middle-low-grade ductal carcinoma in situ of the breast [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(06): 631-635.
[15]	Bo Kong, Jing Zhang, Ke Lyu. Review on the role of ultrasonography in the diagnosis and treatment of complex ventral hernia [J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2023, 17(06): 670-673.

Please choose a citation manager

Content to export