Dynamic evaluation of stress urinary incontinence and pelvic organ prolapse by 640 slice CT
-
摘要: 目的:女性压力性尿失禁(FSUI)和盆腔脏器脱垂(POP)是中老年女性常见的问题,本研究为了探讨640层螺旋CT(640-MSCT)诊断FSUI和POP的可能性。方法:本研究招募了62例FSUI患者(SUI组)、96例POP患者(POP组)和50例健康女性志愿者(对照组)进行640-MSCT骨盆扫描。所有志愿者和患者在排尿前、排尿时和排尿后进行扫描,然后用640-MSCT扫描图像重建3D和4D图像,由2名放射科医师进行复查。通过观察这些图像,我们测量并比较了每个时期的耻骨尾骨线(PCL)、H线、M线、PCL到膀胱颈(PCL-BN)、PCL到宫颈(PCL-c)、尿道倾斜角(UIA)和膀胱尿道后角(PUVA)。结果:本研究比较了志愿者和患者(SUI患者和POP患者)的结果。实验组和对照组中的生育状况和BMI比较差异无统计学意义(P>0.05)。结果表明,各组H线、M线排尿前、排尿及排尿后比较差异均有统计学(P<0.01,P<0.05)。各组排尿时PCL-BN和PCL-C均降低。SUI组和POP组中部分受试者排尿前PCL-BN在PCL线以下,排尿时更加明显。排尿时,POP组中PCL-C明显下降。对照组的UIA和PUVA对比SUI组和POP组在排尿时差异有统计学意义(P<0.05)。结论:采用640-MSCT的3D和4D CT图像进行SUI和POP诊断是一种敏感且具体可行的方法。Abstract: Objective: Female stress urinary incontinence(FSUI) and pelvic organ prolapse(POP) are common problems for adult females. This article is aimed at exploring the possibility of using 640-Multislice CT(640-MSCT) in diagnosing the FSUI and POP. Method: We recruited 62 FSUI patients(SUI group), 96 POP patients(POP group) and 50 healthy female volunteers(control group) to do the pelvis scan by 640-MSCT. All the volunteers and patients had been scanned in the period of pre-voiding, voiding and post-voiding, then 3 D and 4 D images were reconstructed from 640-MSCT scanning images and reviewed by two radiologists. By observing these images, we measured and compared the pubococcygeal line(PCL), H line, M line, length from PCL to bladder neck(PCL-BN) and cervix(PCL-C), urethral inclined angle(UIA) and posterior urethrovesical angle(PUVA) in every period. Result: We compared between the results of volunteers and the results of patients(SUI patients and POP patients). The difference in fertility status or BMI between experiment groups and control group showed no statistical significance(P>0.05). H line and M line showed statistical difference in pre-voiding, voiding and post-voiding period between experiment groups and control group(P<0.01, P<0.05). PCL-BN and PCL-C decreased when voiding in each group. In some candidates of SUI and POP group, PCL-BN was below the bladder neck before voiding, and it was getting worse when voiding. PCL-C decreased significantly in POP group when voiding. UIA and PUVA had statistical difference between control group and SUI group and POP group when voiding.Conclusion: It is a sensitive and specific method to diagnose SUI and POP according to 3 D and 4 D CT images using 640-MSCT.
-
-
[1] 刘晋宏.昆明两社区成年女性盆底功能障碍性疾病的流行病学调查[D].昆明:昆明医科大学,2013.
[2] Sung VW,Hampton BS.Epidemiology of pelvic floor dysfunction[J].Obstet Gynecol Clin North Am,2009,36(3):421-443.
[3] Fritsch H,Lienemann A,Brenner E,et al.Clinical anatomy of the pelvic floor[J].Adva Anat Embryol Cell Biol,2004,175:1-64.
[4] DeLancey JO.Anatomy and biomechanics of genital prolapse[J].Clin Obstet Gynecol,1993,36(4):897-909.
[5] Petros EP,Woodman PJ.The Integral Theory of continence[J].Int Urogynecol J Pelvic Floor Dysfunct,2008,19(1):35-40.
[6] DeLancey J O.Structural support of the urethra as it relates to stress urinary incontinence:the hammock hypothesis[J].Am J Obstet Gynecol,1994,170(6):1713-1720.
[7] Corton MM.Anatomy of the pelvis:how the pelvis is built for support[J].Clin Obstet Gynecol,2005,48(3):611-626.
[8] Ahmad AN,Hainsworth A,Williams AB,et al.A review of functional pelvic floor imaging modalities and their effectiveness[J].Clin Imaging,2015,39(4):559-565.
[9] 熊坤林,龚水根,张伟国.盆底影像解剖与盆底功能性疾病的关系[J].世界华人消化杂志,2005,13(1):76-79.
[10] Picchia S,Rengo M,Bellini D,et al.Dynamic MR of the pelvic floor:Influence of alternative methods to draw the pubococcygeal line(PCL)on the grading of pelvic floor descent[J].Eur J Radiol Open,2019,6:187-191.
[11] Tunn R,Goldammer K,Neymeyer J,et al.MRI morphology of the levator ani muscle,endopelvic fascia,and urethra in women with stress urinary incontinence[J].Eur J Obstet Gynecol Reprod Biol,2006,126(2):239-245.
[12] Singh K,Jakab M,Reid WM,et al.Three-dimensional magnetic resonance imaging assessment of levator ani morphologic features in different grades of prolapse[J].Am J Obstet Gynecol,2003,188(4):910-915.
[13] Pannu HK,Kaufman HS,Cundiff GW,et al.Dynamic MR imaging of pelvic organ prolapse:spectrum of abnormalities[J].Radiographics,2000,20(6):1567-1582.
[14] 陈映鹤,毛传万,何有华,等.磁共振成像在压力性尿失禁诊断中的应用价值[J].临床泌尿外科杂志,2005,20(7):401-402.
[15] Dietz HP,Clarke B.The urethral pressure profile and ultrasound imaging of the lower urinary tract[J].Int Urogynecol J Pelvic Floor Dysfunct,2001,12(1):38-41.
[16] 沈洪君,胡正伟,霍文谦,等.动态MRI在评估女性压力性尿失禁患者膀胱尿道解剖及功能学中的意义[J].局解手术学杂志,2014,23(2):162-164,167.
[17] Bertschinger KM,Hetzer FH,Roos JE,et al.Dynamic MR imaging of the pelvic floor performed with patient sitting in an open-magnet unit versus with patient supine in a closed-magnet unit[J].Radiology,2002,223(2):501-508.
[18] Orno AK,Dietz HP.Levator co-activation is a significant confounder of pelvic organ descent on Valsalva maneuver[J].Ultrasound Obstet Gynecol,2007,30(3):346-350.
[19] 王毅,龚水根,张伟国,等.盆底功能性疾病的动态MRI研究[J].临床放射学杂志,2004,23(5):401-404.
[20] Enhorning G.Simultaneous recording of intravesical and intra-urethral pressure.A study on urethral closure in normal and stress incontinent women[J].Acta Chir Scand Suppl,1961,Suppl 276:1-68.
[21] DeLancey JO,Trowbridge ER,Miller JM,et al.Stress urinary incontinence:relative importance of urethral support and urethral closure pressure[J].J Urol,2008,179(6):2286-2290.
[22] Naranjo-Ortiz C,Shek KL,Martin AJ,et al.What is normal bladder neck anatomy?[J].Int Urogynecol J,2016,27(6):945-950.
[23] 陆继红,李茜,朱红,等.超声测量膀胱尿道后角对诊断压力性尿失禁的临床价值[J].中华妇产科杂志,2010,45(5):338-341.
[24] Weil EH,van Waalwijk van Doorn ES,Heesakkers JP,et al.Transvaginal ultrasonography:a study with healthy volunteers and women with genuine stress incontinence[J].Eur Urol,1993,24(2):226-230.
-
计量
- 文章访问数: 492
- PDF下载数: 716
- 施引文献: 0
下载: