Levels of pelvic floor support; what do they look like on Magnetic Resonance Imaging?

Objective:

To describe the MRI-appearance and optimal imaging planes for studying the three Levels of support.

Material/Methods:

N = 10 healthy women who volunteered to serve as normal controls on studies of pelvic organ prolapse were selected from our research MRI-database. Resting T2-weighted-proton-density-images were made in standard orthogonal planes.

Results:

In all 10 women, all three Levels and their characteristic appearances could be identified: In Level I the cardinal ligaments are seen coronally (Figure 1c), both cardinal and uterosacral ligaments could be seen in the axial scan-plane (Figure 1 d). The analysis of Level II showed the lateral vagina adjacent to the levator ani muscle but with clear distinction between them (Figure 1b, c, e). Loss of separation between the vagina and the levator ani muscle could be seen best in Level III (Figure 1b&f). The transition Level I to Level II is seen in the mid-urethral axial and coronal scan (Figure 1b) where the separation between the vagina and pelvic wall disappears, whereas the transition Level II to III can be identified in the mid-vaginal plane in the coronal scan (Figure 1c).

Conclusions:

MRI can be used to visualize the characteristic appearance of the structures previously described as Levels of support.

Abb. 1: MRI characteristics of Levels of support.