男性和女性盆腔器官脱垂的磁共振成像对左旋的定量研究
Summary
在这里, 我们提出了一个协议, 以标准化测量的提升机, 并通过磁共振成像。目的是通过比较男女盆腔脱垂患者的休息和紧张值, 使用一致的解剖骨性地标, 从图像分析中提取生物力学推断。
Abstract
在这里, 我们提出了一个协议, 以检查提升和盆腔器官脱垂, 在 Valsalva 机动和同时疏散声学凝胶, 使用水平方向 1.5 T 磁共振 (MR) 扫描仪的男性和女性的悬浮液间隙。在中矢状图像上, 骨盆器官的垂直距离以毫米为单位, 相对于 hymen 平面 (女性) 和与共生 pubis (男性) 的下边界, 前面有-(上) 或 + (下) 的迹象。在轴向图像上, 利用三个关键图像的自由手追踪方法, 以平方厘米的形式计算悬浮物, 通过中突 (i 级), 切线到共生的下边界 (ii 级), 并在最大前直肠的边缘。墙体凸起 (三级)。对休息和紧张的地区进行比较, 以找到增加的百分比的证据。目的是在不受异物干扰或考官接近的情况下, 提供盆腔器官下降和分离最大程度的客观证据, 以克服盆腔检查和会阴检查的局限性(即主观性和性方面的局限性 [仅限女性])。
Introduction
当在悬浮物间隙内作用的力不再被外界对抗, 导致异常扩大和器官撞击时, 骨盆器官脱垂 (POP) 就会发展起来。有几个因素导致这种疾病, 包括韧带, 筋膜, 或肌肉强直活动。无论所涉及的机制如何, 增加的中断规模都被认为是评估无法关闭该机制的可靠指数。通常情况下, 盆腔支撑的状态是在盆腔检查1中通过观察子宫颈、阴道先端和阴道壁在 Valsalva 机动过程中的位置来确定的。然而, 这种方法的不准确, 加上未能识别所有相关的网站2,3和性相关的收缩 (仅限女性), 导致临床医生和研究人员寻求替代方法, 即诊断成像。
目前确定中断大小的方法包括会阴超声 (tpus)4,5和最近的磁共振成像 (mri)。不幸的是, 现有的方法进行检查和测量的个别参数在研究人员6,7,8,9, 10,11,12,1 3日, 对研究结果进行比较很困难。此外, 在最常见的盆腔下降过程的定义和术语方面, 以及在所采用的系统14、15 的分类和量化方面, 仍然存在重大差异。
这项研究强调了 MRI 相对于其他方法的优势, 并描述了定量的技术细节和诊断标准的 POP 在男性和男性。特别是, 描述的重点是在紧张的情况下, 在病人仰视的情况下, 对盆腔器官下降和提升体的扩大进行量化, 以证明缺乏垂直定向的 mr 系统16,17 (即, 重力不会对检测与 POP 相关的各种变化产生不利影响)。
Protocol
根据意大利放射学会的《国家准则》进行了涉及人体的程序 1. 患者准备 帮助患者填写一份表格, 提供有关其病史、当前症状、治疗 (医疗或手术) 以及先前的病历 (如果有的话) 的信息。 在开始检查之前, 请征得每位患者的书面同意。 事先清楚地解释了程序的特点和目的, 包括各种动作的表现, 如挤压、拉紧和直肠排空。 提供有关手术的持续时间 (…
Representative Results
2012年至2018年期间, 该协议已在意大利三个不同的诊断中心成功采用, 平均每月累计考试速度为 30±4, 使用相同的 1.5 Tmr 扫描仪型号和技术设置 (见表 1和材料)。在此期间, 对以下三个主要疾病类别的男女患者进行了 2 000多次检查: 盆腔器官脱垂和疏散障碍 (第1组)、肛周瘘 (第2组) 和慢性盆腔疼痛。已知或怀疑神经病变 ( 第 3 组 ) 。患者人口中最相关?…
Discussion
这种方法比盆腔检查有明显的优势, 仅限于评估泌尿生殖道的中断, 只在女性。相反, 这里提出的方法检查整个提升机在男性和男性之间的间隙。此外, 虽然很容易通过检查的触诊的妇科医生, 女性裂隙只能近似地计算与统治者, 以产生一个椭圆形1的面积。同样, 与2和 3-d tpus4,5相比, 确实存在优势, 这两种优势不适合男性患者。然而, 该协?…
Disclosures
The authors have nothing to disclose.
Acknowledgements
提交人特别感谢护士保拉·加拉维洛和朱利亚·梅拉拉在检查期间提供的宝贵协助。
Materials
| MR scanner | Philips Medical Systems, High Tech Campus 37, 5656 AE, Eindhoven, The Netherlands |
Description: 1.5 T horizontally oriented, Multiva model, SENSE XL Torso coil Procedure: Position the patient in the left lateral decubitus on the diagnostic table with the coil warpped around the pelvis |
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| Catheter | Convatek ltd, First avenue Deeside, Flintshire CH5 2NU UK |
Description: Sterile vaginal catheter, 16 ch,180 mm long, 3 mm wide Procedure: Gently insert the lubricated tip inside the anal canal for contrast administration with patients in the left side position |
|
| Holder | Kartell Plastilab, Artiglas Srl, Via Carrara Padua, Italy | Description: Universal test-tube holder with multiple 13-mm holes Procedure: Put 3 empty syringes vertically inside the holes with the outlet cone down |
|
| Syringe | Pikdare Srl, Via Saldarini Catelli 10 , 22070 Casnate con Bernate (Como) Italy | Description: Sterile, latex free,60 mL graduated transparent cylinder, catheter cone Procedure: Fill with contrast, adjust the plunger and connect to the catheter |
|
| Contrast | Ceracarta SpA, Via Secondo Casadei 14 47122 Forlì Italy |
Description: Eco supergel not irritant, water soluble, salt free Procedure: Dilute the content of each syringe adding 30 mL of tap water to 50 mL of acustic gel |
|
| Mixer device | Kaltek Srl, Via del Progresso 2 Padua Italy |
Description: Kito-Brush for endovaginal sampling Procedure: Rotate one full turn 10-20 times until obtaining an homogeneous gel |
|
| Pad | Fater SpA, Via A. Volta 10, 65129 Pescara Italy |
Description: Pad for incontinent subjects Procedure: Wrap around patient's pelvis to collect any material and prevent diagnostic table contamination |
|
| Lubricant | Molteni farmaceutici, Località Granatieri Scandicci (Florence) Italy |
Description: Luan gel 1% Procedure: Apply on the tip of catheter before insertion |
|
| Apron | Mediberg Srl, via Vezze 16/18 Calcinate 24050 (Bergamo) Italy |
Description: Kimono Procedure: Put on counteriwise (opening back) to maintain patient's dignity |
|
| Gloves | Gardening Srl, Via B. Bosco 15/10 16121 Genova Italy |
Description: Nitrile, latex free, no talcum powdered Procedure: Wear during contrast preparation and catheter insertion; change regularly to prevent cross contamination |
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Cite This Article
Piloni, V., Bergamasco, M., Chiapperin, A. Quantification of Levator Ani Hiatus Enlargement by Magnetic Resonance Imaging in Males and Females with Pelvic Organ Prolapse. J. Vis. Exp. (146), e58534, doi:10.3791/58534 (2019).