Evaluation Of Pelvic Floor Function In Female Patients With SUI By Urinating MRI Cine

Objective: To explore the clinical value of urinating MRI cine technology in the evaluation of pelvic floor function in female patients with stress urinary incontinence(SUI),evaluate its diagnostic performance in identifying female SUI and provide an option for non-invasive examination of female SUI.Methods: From August 2020 to December 2021,women with complaints of involuntary urinary leakage and vaginal mass prolapse with increased abdominal pressure were collected from the gynecology clinic of our hospital,and physical examination was performed by a gynecologist.Those who met the criteria of involuntary urine leakage with increased abdominal pressure and stress-induced test and bladder neck lift test were considered as the SUI group;those with pelvic organ prolapse(POP)were recruited as the POP group;those without SUI and POP were recruited as the health control(HC)group,and all of them underwent urinating MRI cine examination.The gynecologists used the German ANDROMEDA urodynamic instrument to examine the subjects who were willing to undergo urodynamic examination.A Siemens Skyra 3.0T high-field MRI scanner from Germany was used to perform the urinating MRI cine image acquisition,and one-way ANOVA analysis,non-parametric test,Chi-square test were used to compare the clinical and imaging parameters between the SUI,POP and HC groups.The receiver operating characteristic(ROC)curves were drawn,the areas under the curves(AUC)and optimal cutoff values,sensitivity,specificity and accuracy were calculated.The correlation between their urinating MRI cine and the parameters of urodynamic examination was analyzed by Pearson correlation analysis for subjects who underwent urodynamic examination,and P<0.05 was considered a statistically significant difference.Results: A total of 30 cases were included in the SUI group,of which 11 cases underwent urodynamic examination,31 cases in the POP group,of which 9 cases underwent urodynamic examination,and a total of 30 cases in the HC group.There were statistically significant differences in age,gravidity,parity and number of transvaginal deliveries between the three groups of SUI,POP,and HC.There were statistically significant differences in distance of bladder neck from PCL,distance of the anterior and inferior cervix from PCL,anterior angle of urethra,urethral mobility,levator plate angles,iliococcygeal angles,urethral length,functional urethral length,bladder neck funnel sign at rest and urination phase and endourethral angle at rest phase between the three groups(P<0.05).All the parameters were valuable for diagnosis of SUI,while the anterior angle of urethra at urination phase had the best diagnostic value.Taken 42.42°as the optimal cut-off value,the accuracy,sensitivity and specificity was 91.90%,86.70%,83.30%,respectively.Correlation between urinating MRI cine data and parameters of urodynamic examination in patients with SUI and POP: urethral length at rest phase was positively correlated with maximum urethral pressure and maximum urethral closure pressure;the anterior angle of urethra at rest phase urethra was negatively correlated with the initial urinary urge forced urinary muscle pressure;the endourethral angle at rest phase was negatively correlated with the initial urinary urge forced urinary muscle pressure and the strong urinary urge forced urinary muscle pressure;the left iliococcygeal angle was positively correlated with maximum urethral pressure and maximum urethral closure pressure;the urethral mobility was positively correlated with the length of the functional curve and the maximal forced urinary muscle pressure in the urinating phase;the retro vesicourethral angle at urination phase was negatively correlated with urinary flow time;urinating time,maximum urethral pressure and maximum urethral closure pressure;the distance from the anterior and inferior cervix to the PCL at urination phase was positively correlated with the maximal urinary flow rate forced urinary muscle pressure(P<0.05).Conclusion: Each imaging sign on urinating MRI cine has some diagnostic efficacy for SUI.Anterior angle of urethra at rest and urination phase,and distance of bladder neck from PCL at urination phase are expected to be important indicators for the diagnosis of SUI,and identifying cases without SUI by urinating MRI cine can help reduce unnecessary urodynamic testing.