The High Rate of Discordance Between Clinical Symptoms and MRI Findings in Patients with Pelvic Floor Dysfunction

Pelvic floor dysfunctions (PFD) are common disorders among women and affect about 50% of them over 50. About 400,000 American women undergo surgery due to the severity of these disorders. The aim of this study was to investigate the correlation of patients' symptoms with both static and dynamic MRI findings.

In this study, we performed MRI on 60 women suspected of pelvic floor disorders in the Imam Khomeini Hospital complex. Following rectal enema of 60-120 cc sonography gel and vaginal enema of 5-10 cc gel, we performed MRI with 3 Tesla equipment (Siemens Magnetom Trio) utilizing multichannel (16 rows) surface coil on the supine position. Static MRI was performed with high-resolution T2 FSE sequences in sagittal, axial, and coronal planes. Dynamic imaging was done using mid-sagittal T2 HASTE or true FISP in 3 different phases (rest, squeeze, strain and defecogram). The radiologists were blinded to the clinical data of patients.

Our study included 60 patients with a mean age of 52.7±14.3 years. Regarding the MRI findings in patients with urinary symptoms, except for the level I fascial defect, the other findings were not related to the patients' symptoms. Among patients with defecation symptoms, other MRI findings did not have a significant relationship with the patient's symptoms except for severe rectal descent. The association between endopelvic fascial defects and levator muscle injury with sexual complaints was not statistically significant.

 In conclusion, these results suggest that the patients' symptoms are not good predictors for MRI findings and are limited in reliability. Thus, MRI must be counted necessary to further evaluate patients with pelvic floor abnormalities. Other studies regarding MRI findings' correlation with different symptoms in these patients are required.