Pelvic organ prolapse (POP) is a common condition in women above 40 years. Symptoms can be relieved with surgery, though this therapeutic option has a 30% recurrence rate. Nowadays, MRI is only performed in supine position for complex POP cases. This supine position is inconsistent with the maximal extent of POP. Therefore MD&I employs a low-field MRI system (0.25T), where the patient can be scanned in upright position. Patients are scanned before and after prolapse surgery, in supine and upright position. The protocol includes static imaging as well as dynamic imaging. Dynamic imaging gives more insight about the functionality of the pelvic floor musculature. Using distances of the pelvic organs from the pubococcygeal line (PCL), a reference line that approaches the pelvic floor, the degree of prolapse can be quantified. Upright scanning could give more insight into the dynamics and the true degree of the prolapse, thus improving diagnostics. Evaluation of the clinical parameters after surgical intervention, could provide additional information on the prevention of recurrence.
The following two examples of a mid-sagittal view show the clear influence of gravity on the position of the pelvic organs. The left image was made in supine position and the right image in upright positon
This research is performed by Judith olde Heuvel, with cooperation from the Gynaecology departments of the UMC Utrecht, Medisch Spectrum Twente and Ziekenhuisgroep Twente.