Standardization of dynamic magnetic resonance imaging measurements of pelvic organ prolapse: can the PICS line help?

Excerpt

Dynamic magnetic resonance imaging (MRI) of the pelvis has been rapidly introduced into urogynecological research and practice in recent years mainly to address the shortcomings of clinical assessment systems in women with pelvic organ prolapse (POP). The primary objective was to better select candidates for surgical intervention and choose the appropriate procedure in order to reduce recurrences by allowing accurate identification and objective measurement of prolapse and simultaneous topographic assessment of the pelvis at rest and straining [1‐5]. MRI is particularly indicated in women with multi-compartment POP and in those who had undergone previous repair, as imaging can reveal more extensive prolapse than physical examination alone with detection rates similar to other conventional fluoroscopic and ultrasound methods [1, 3, 4]. Staging of POP using MRI has also been suggested by measuring the perpendicular distance between several reference points and lines in each compartment at rest and after straining [1‐5]. The two most commonly used lines are one connecting the inferior aspect of the pubic symphysis to the last coccygeal joint, the pubococcygeal line (PCL), and one extending caudally along the long axis of the symphysis pubis, the midpubic line (MPL). Several MRI staging systems have been published for both of these lines [1, 3, 4]. …