Abstract:

Abstract： Objective To investigate the value of dynamic MRI in diagnosing female POP. Methods Totally 78 women suffering with POP underwent dynamic MRI in Peking University Third Hospital from Feb. 2012 to Mar. 2014. Analyze the measurement results and diagnoses according to POP-Q and HMO classification. Results The correlations between measurement results of POP-Q and MRI were assessed by calculation of the Spearman correlation coefficients. The correlation coefficient of Aa-bladder neck was 0.745，Ba-bladder base 0.836，and C-cervix/vaginal vault 0.867. The correlation coefficient of Bp-cul-de-sac was 0.367 and Ap-posterior vaginal wall 0.481. There was very strong correlation between clinical examination and MRI in anterior and middle pelvic cavity but moderate correlation in posterior pelvic cavity. Comparisons between positive rate of POP-Q and HMO classification was performed with Kappa tests.The Kappa values were 0.313,0.794 and 0.385，and the χ2 values were 3.368（P=0.064），5.143（P=0.016） and 15.042（P<0.01） in anterior，middle and posterior compartment respectively. The positive rate of the two methods was of no significant difference in anterior compartment，but was higher of POP-Q in the middle and of MRI in the posterior. Consistency of grading POP between POP-Q and HMO classification was poor in anterior（K=0.063），middle （K=0.328） or posterior compartment （K=0.167）. Conclusion There is excellent correlation in diagnosing POP between clinical examination and dynamic MRI in anterior and middle compartment. Dynamic MRI is more accurate than clinical diagnosis in posterior compartment. It can be an effective supplemental method to clinical examination.

Key words: pelvic organ prolapse, dynamic magnetic resonance imaging, pelvic organ prolapse quantification

摘要：

目的 探讨动态磁共振成像（MRI）在女性盆腔器官脱垂（POP）诊断中的应用价值。方法　收集2012年2月至2014年3月在北京大学第三医院妇科门诊就诊的POP病人78例，对其临床检查并进行盆腔器官脱垂定量（POP-Q）分期及HMO分度，与动态MRI的测量及诊断结果进行比较分析。结果　临床检查与动态MRI的相关性：Aa与膀胱颈、Ba与膀胱底、C与宫颈或阴道穹窿最低点到H线的距离的Spearman相关系数分别为0.745、0.836、0.867，相关性好；Bp与子宫直肠陷凹最低点、Ap与直肠肛管连接处直肠前壁到H线的距离的相关系数分别为0.367、0.481，仅中度相关。两种分期在诊断前、中、后盆腔脱垂的Kappa检验结果分别为：K=0.313、0.794、0.385，前后盆腔一致性弱，中盆腔一致性强；χ2检验结果分别为：χ2=3.368（P=0.064）、5.143（P=0.016）、15.042（P＜0.01），前盆腔两种检查的诊断率差异无统计学意义，中盆腔POP-Q的诊断率较高，后盆腔动态MRI的诊断率较高。两种分期在评价前、中、后盆腔脱垂程度的Kappa检验结果分别为K=0.063、0.328、0.167，一致性均差。结论　动态MRI能够准确评估前、中盆腔器官脱垂，评估后盆腔器官脱垂比临床检查更具有优势。动态MRI可以作为临床检查的有效补充。

关键词: 盆腔器官脱垂, 动态磁共振成像, POP-Q分期