Share:
Share this content in WeChat
X
Experience Exchang
Analysis of the structure of normal female urethral sphincter complex and levator ani muscles by magnetic resonance diffusion tensor imaging
ZHANG Jing  YANG Zitao  ZHAO Zhiheng  WU Yue  CHENG Jingliang  CHE Yingyu 

Cite this article as: Zhang J, Yang ZT, Zhao ZH, et al. Analysis of the structure of normal female urethral sphincter complex and levator ani muscles by magnetic resonance diffusion tensor imaging[J]. Chin J Magn Reson Imaging, 2022, 13(4): 128-131. DOI:10.12015/issn.1674-8034.2022.04.025.


[Abstract] Objective To explore the influence of delivery and age on the microtissue structure of urethral sphincter complex and levator ani muscles in normal female by 3.0 T MR diffusion tensor imaging, and to provide an objective basis for analyzing the pathogenesis of pelvic floor dysfunction.Materials and Methods Prospectively, 103 women without pelvic floor dysfunction were collected and divided into 24 cases in the normal control group and 79 cases in the menstrual group based on the presence or absence of the history of delivery, and then the menstrual group was divided by age group into those ≤30 years (19 cases), 31-44 years (22 cases), 45-59 years (27 cases) and ≥60 years old group (11 cases). A two-dimensional diffusion-weighted transverse spin-gradient echo (SE-GRE) pulse sequence was used to perform pelvic floor diffusion tensor imaging (DTI) in all subjects, and DTI parameters, including fraction anisotropy (FA), apparent diffusion coefficient (ADC) values, and three eigenvalues (λ1, λ2, and λ3) were measured in the middle urethral circle sphincter, longitudinal muscle, puborectalis muscle, and iliococcygeus muscle fibers to .analyze the effects of delivery history and different age groups on the microstructure of the urethra and levator ani muscles.Results (1) The FA value of the puborectalis muscle in the group under 30 years was smaller than that of the normal control group in the menstrual group, and the difference was statistically significant (t=2.206, P=0.030); (2) There was a statistically significant difference between ADC values, λ2 values and λ3 values of the middle urethral ring sphincter between different age groups in the transmaternal group (F=3.547, 4.105, 3.596, P=0.018, 0.009, 0.017), but there was no statistically significant difference in the DTI parameters of the longitudinal muscle of the middle urethra (P>0.05); (3) In the multiparous women group, the FA value, ADC value, λ1 value and λ2 value of the puborectalis muscle were compared between different age groups, and the differences were statistically significant (F=8.071, 6.051, 6.672, 3.688, P<0.001, P=0.001, P<0.001, P=0.013); (4) In the multiparous female group, the FA value, ADC value and λ3 value of the iliococcygeus muscle were compared between different age groups, and the differences were statistically significant (F=5.676, 3.110, 5.175, P=0.001, 0.028, 0.002).Conclusions Delivery mainly affects the microstructure of the puborectalis muscle, the age factor has a certain influence on the microstructure changes of the urethral annular sphincter and levator ani muscles. DTI technology is of great value in observing the pelvic floor muscle structure and evaluating the microstructure changes.
[Keywords] diffusion tensor imaging;urethral sphincter complex;levator ani muscles;age;delivery;pelvic floor dysfunction

ZHANG Jing   YANG Zitao   ZHAO Zhiheng   WU Yue   CHENG Jingliang   CHE Yingyu*  

Department of Magnetic Resonance Imaging, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China

Che YY, E-mail: cheyingyujia@126.com

Conflicts of interest   None.

Received  2021-12-10
Accepted  2022-04-01
DOI: 10.12015/issn.1674-8034.2022.04.025
Cite this article as: Zhang J, Yang ZT, Zhao ZH, et al. Analysis of the structure of normal female urethral sphincter complex and levator ani muscles by magnetic resonance diffusion tensor imaging[J]. Chin J Magn Reson Imaging, 2022, 13(4): 128-131.DOI:10.12015/issn.1674-8034.2022.04.025

[1]
Kobi M, Flusberg M, Paroder V, et al. Practical guide to dynamic pelvic floor MRI[J]. J Magn Reson Imaging, 2018, 47(5): 1155-1170. DOI: 10.1002/jmri.25998.
[2]
Al-Najar MS, Ghanem AF, AlRyalat SAS, et al. The usefulness of MR defecography in the evaluation of pelvic floor dysfunction: our experience using 3T MRI[J]. Abdom Radiol (NY), 2017, 42(9): 2219-2224. DOI: 10.1007/s00261-017-1130-7.
[3]
García del Salto L, de Miguel Criado J, Aguilera del Hoyo LF, et al. MR imaging-based assessment of the female pelvic floor[J]. Radiographics, 2014, 34(5): 1417-1439. DOI: 10.1148/rg.345140137.
[4]
Pang H, Zhang L, Han S, et al. A nationwide population-based survey on the prevalence and risk factors of symptomatic pelvic organ prolapse in adult women in China-a pelvic organ prolapse quantification system-based study[J]. BJOG, 2021, 128(8): 1313-1323. DOI: 10.1111/1471-0528.16675.
[5]
Morris VC, Murray MP, Delancey JO, et al. A comparison of the effect of age on levator ani and obturator internus muscle cross-sectional areas and volumes in nulliparous women[J]. Neurourol Urodyn, 2012, 31(4): 481-486. DOI: 10.1002/nau.21208.
[6]
Lope-Piedrafita S. Diffusion tensor imaging (DTI)[M]//Preclinical MRI. New York, NY: Springer New York, 2018: 103-116. DOI: 10.1007/978-1-4939-7531-0_7.
[7]
Dietz HP. The aetiology of prolapse[J]. Int Urogynecol J Pelvic Floor Dysfunct, 2008, 19(10): 1323-1329. DOI: 10.1007/s00192-008-0695-7.
[8]
Kepenekci I, Keskinkilic B, Akinsu F, et al. Prevalence of pelvic floor disorders in the female population and the impact of age, mode of delivery, and parity[J]. Dis Colon Rectum, 2011, 54(1): 85-94. DOI: 10.1007/DCR.0b013e3181fd2356.
[9]
Wu D, Zhang CF, Zhang QY, et al. Analysis of the prevalence and influencing factors of perimenopausal syndrome in women[J]. Matern Child Heal Care China, 2022, 37(1): 158-161. DOI: 10.19829/j.zgfybj.issn.1001-4411.2022.01.046.
[10]
Li N, Cui C, Cheng Y, et al. Association between magnetic resonance imaging findings of the pelvic floor and de novo stress urinary incontinence after vaginal delivery[J]. Korean J Radiol, 2018, 19(4): 715-723. DOI: 10.3348/kjr.2018.19.4.715.
[11]
Santiago AC, O'Leary DE, Quiroz LH, et al. Is there a correlation between levator ani and urethral sphincter complex status on 3D ultrasonography?[J]. Int Urogynecol J, 2015, 26(5): 699-705. DOI: 10.1007/s00192-014-2577-5.
[12]
Verbeek M, Hayward L. Pelvic floor dysfunction and its effect on quality of sexual life[J]. Sex Med Rev, 2019, 7(4): 559-564. DOI: 10.1016/j.sxmr.2019.05.007.
[13]
Milsom I, Gyhagen M. The prevalence of urinary incontinence[J]. Climacteric, 2019, 22(3): 217-222. DOI: 10.1080/13697137.2018.1543263.
[14]
Mistry MA, Klarskov N, DeLancey JO, et al. A structured review on the female urethral anatomy and innervation with an emphasis on the role of the urethral longitudinal smooth muscle[J]. Int Urogynecol J, 2020, 31(1): 63-71. DOI: 10.1007/s00192-019-04104-7.
[15]
Roy C, Ohana M, Labani A, et al. Evaluation of the female bladder neck and urethra using MRI with fiber tractography: prospective study on a large cohort of continent women[J]. Neurourol Urodyn, 2021, 40(6): 1441-1449. DOI: 10.1002/nau.24674.
[16]
Perucchini D, DeLancey JO, Ashton-Miller JA, et al. Age effects on urethral striated muscle. II. Anatomic location of muscle loss[J]. Am J Obstet Gynecol, 2002, 186(3): 356-360. DOI: 10.1067/mob.2002.121090.
[17]
Maiborodin IV, Yarin GY, Vilgelmi IA, et al. Age-related changes of the female urethra[J]. Uspekhi Gerontol, 2020, 33(5): 945-955.
[18]
Chow RS, Medri MK, Martin DC, et al. Sonographic studies of human soleus and gastrocnemius muscle architecture: gender variability[J]. Eur J Appl Physiol, 2000, 82(3): 236-244. DOI: 10.1007/s004210050677.
[19]
Karampinos DC, King KF, Sutton BP, et al. Myofiber ellipticity as an explanation for transverse asymmetry of skeletal muscle diffusion MRI in vivo signal[J]. Ann Biomed Eng, 2009, 37(12): 2532-2546. DOI: 10.1007/s10439-009-9783-1.
[20]
Cui C, Zhao YJ, Cui DW, et al. In vivo evaluation of the levator ani muscle in primiparous women using diffusion tensor imaging and fiber tractography[J]. Int J Gynecol Obstet, 2021. DOI: . DOI: 10.1002/ijgo.13897.
[21]
Miller JM, Low LK, Zielinski R, et al. Evaluating maternal recovery from labor and delivery: bone and levator ani injuries[J]. Am J Obstet Gynecol, 2015, 213(2): 188.e1-188188.e11. DOI: 10.1016/j.ajog.2015.05.001.
[22]
Krofta L, Havelková L, Urbánková I, et al. Finite element model focused on stress distribution in the levator ani muscle during vaginal delivery[J]. Int Urogynecol J, 2017, 28(2): 275-284. DOI: 10.1007/s00192-016-3126-1.

PREV Construction of prediction model of intermediate risk factors for early cervical cancer based on preoperative MRI radiomics and clinical features
NEXT A study of IVIM magnetic resonance imaging to identify wrist synovitis in rheumatoid arthritis
  



Tel & Fax: +8610-67113815    E-mail: editor@cjmri.cn