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Dynamic MR Imaging of the Pelvic Floor in Asymptomatic Subjects

Vicky Goh1, Steve Halligan1, Glenda Kaplan1, Jeremiah C. Healy2 and Clive I. Bartram1

1 Intestinal Imaging Centre, Level 4V, St. Mark's Hospital, Northwick Park, Watford Rd., Harrow, London, HA1 3UJ, United Kingdom.
2 Department of Radiology, Chelsea & Westminster Hospital, Fulham Rd., London, SW10 9NH, United Kingdom.



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Fig. 1A. —Position of bladder base relative to pubococcygeal line. Ladder plots show position of bladder base relative to pubococcygeal line at rest and during maximum strain for 25 asymptomatic men (A) and 25 asymptomatic women (B). Note that bladder base descends below this line in three women, indicating cystocele. {circ} = multiparous, • = nulliparous.

 


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Fig. 1B. —Position of bladder base relative to pubococcygeal line. Ladder plots show position of bladder base relative to pubococcygeal line at rest and during maximum strain for 25 asymptomatic men (A) and 25 asymptomatic women (B). Note that bladder base descends below this line in three women, indicating cystocele. {circ} = multiparous, • = nulliparous.

 


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Fig. 2A. —40-year-old asymptomatic multiparous woman. Sagittal T1-weighted fast-field-echo MR image of pelvis at rest shows pubococcygeal line (black line) and no apparent abnormality.

 


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Fig. 2B. —40-year-old asymptomatic multiparous woman. Sagittal T1-weighted fast-field-echo MR image of pelvis at strain shows cystocele diagnosed because bladder base descent is below pubococcygeal line (white arrow). Cervix has also descended below pubococcygeal line (black arrow).

 


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Fig. 3. —Ladder plot shows position of uterocervical junction relative to pubococcygeal line at rest and during maximum strain for 25 asymptomatic women. Note that uterocervical junction descends below this line in three women, indicating prolapse. {circ} = multiparous, • = nulliparous.

 


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Fig. 4A. —50-year-old asymptomatic nulliparous woman. Sagittal T1-weighted fast-field-echo MR image of pelvis at rest shows pubococcygeal line (black line) and cervix (arrowhead). No apparent abnormality is seen.

 


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Fig. 4B. —50-year-old asymptomatic nulliparous woman. Sagittal T1-weighted fast-field-echo MR image of pelvis at strain shows grade 1 uterocervical prolapse (white arrow) indicated by cervical descent below pubococcygeal line (black line). Note also cystocele (black arrow).

 


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Fig. 5A. —Position of anorectal junction relative to pubococcygeal line. Ladder plots show position of anorectal junction relative to pubococcygeal line at rest and during maximum strain for 25 asymptomatic men (A) and 25 asymptomatic women (B). Note that anorectal junction descent is excessive (>=3 cm of descent) in three men. {circ} = multiparous, • = nulliparous.

 


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Fig. 5B. —Position of anorectal junction relative to pubococcygeal line. Ladder plots show position of anorectal junction relative to pubococcygeal line at rest and during maximum strain for 25 asymptomatic men (A) and 25 asymptomatic women (B). Note that anorectal junction descent is excessive (>=3 cm of descent) in three men. {circ} = multiparous, • = nulliparous.

 

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