Oynamic MRI Study In Female With Different Clinicai Grading Of Stress Urinary Incontinence

Objective Through analyzing the relation between clinical grading of female stress urinary incontinence and dynamic MRI evaluation indicators of pelvic floor, to investigate the value of dynamic MRI in evaluating the severity of female SUI.Materials and Methods According to Ingelman-Sundberg grading,85female SUI patients were divided into three groups:mild, moderate and severe, the control group consisted of32female healthy volunteers. All the SUI patients and volunteers underwent static and dynamic pelvic floor MRI scanning. The changes of dynamic MRI evaluation indicator measurements of pelvic floor were analysed among control group, mild SUI group, moderate SUI group and severe SUI group. ANOVA and χ2test was applied in the intergroup comparisons. LSD-t test was applied in the multiple comparisons.Results1. The comparisons of dynamic MRI evaluation indicator measurements reflecting the morphological and functional change of the support structure around urethra among control group, mild SUI group, moderate SUI group and severe SUI groupPosterior vesicourethral angle:(1)The static measurement:The average from low to high was control group, mild SUI group, moderate SUI group and severe SUI group. There was a significant difference between any two groups(P<0.05), except control group and mild SUI group, moderate SUI group and severe SUI group.(2)The dynamic measurement:The average from high to low was control group, mild SUI group, moderate SUI group and severe SUI group. There was a significant difference between any two groups(P<0.05), except moderate SUI group and severe SUI group.(3)The D-value between rest and straining:The average from high to low was control group, mild SUI group, moderate SUI group and severe SUI group. There was a significant difference between any two groups(P<0.05), except mild SUI group and moderate/severe SUI group, moderate SUI group and severe SUI group.Urethral inclination angle:(1)The static measurement:The average from low to high was control group, mild SUI group, moderate SUI group and severe SUI group. There was a significant difference between any two groups(P<0.05), except control group and mild/moderate SUI group, mild SUI group and moderate SUI group.(2) The dynamic measurement or D-value between rest and straining:The average from high to low was control group, mild SUI group, moderate SUI group and severe SUI group. There was a significant difference between any two groups(P<0.05), except mild SUI group and moderate SUI group.Retropubic space:(1)The static or dynamic measurement:The average from low to high was control group, mild SUI group, moderate SUI group and severe SUI group. There was a significant difference between any two groups(P<0.05), except moderate SUI group and severe SUI group.(2) The D-value between rest and straining:The average from low to high was control group, mild SUI group, moderate SUI group and severe SUI group. There was a significant difference between any two groups(P<0.05), except mild SUI group and moderate SUI group.2. The comparisons of dynamic MRI evaluation indicator measurements reflecting the functional change of intrinsic sphincter deficiency among control group, mild SUI group, moderate SUI group and severe SUI groupFunneling at the bladder neck:Compared with the control group, SUI groups had higher positive rate at rest and on straining. The positive rate showed a increasing trend in mild, moderate and severe SUI group.Urethral length:(1) The static measurement:The average from high to low was control group, mild SUI group, moderate SUI group and severe SUI group. There was a significant difference between any two groups(P<0.05), except mild SUI group and moderate SUI group.(2) The dynamic measurement:The average from high to low was control group, mild SUI group, moderate SUI group and severe SUI group. There was a significant difference between any two groups(P<0.05).(3)The D-value between rest and straining:The average from low to high was control group, mild SUI group, moderate SUI group and severe SUI group. There was a significant difference between any two groups(P<0.05), except control group and mild SUI group, mild SUI group and moderate SUI group.3. The comparisons of dynamic MRI evaluation indicator measurements reflecting the morphological and functional change of levator ani muscle among control group, mild SUI group, moderate SUI group and severe SUI group The thickness of puborectalis:(1)The static or dynamic measurement:The average from high to low was control group, mild SUI group, moderate SUI group and severe SUI group. There was a significant difference between any two groups(P<0.05), except mild SUI group and moderate/severe SUI group, moderate SUI group and severe SUI group.(2)The D-value between rest and straining:There was no statistically significant between any two groups (P>0.05).The transverse diameter of pelvic diaphragm hiatus:(1)The static or dynamic measurement:The average from low to high was control group, mild SUI group, moderate SUI group and severe SUI group. There was a significant difference between any two groups(P<0.05).(2)The D-value between rest and straining:The static or dynamic measurement:The average from low to high was control group, mild SUI group, moderate SUI group and severe SUI group. There was a significant difference between any two groups(P<0.05), except control group and mild SUI group, mild SUI group and moderate SUI group.Levator plate angle:(1)The static measurement:The average from low to high was control group, mild SUI group, moderate SUI group and severe SUI group. There was a significant difference between any two groups(P<0.05), except control group and mild SUI group, mild SUI group and moderate SUI group.(2)The dynamic measurement or D-value between rest and straining:The average from low to high was control group, mild SUI group, moderate SUI group and severe SUI group. There was a significant difference between any two groups(P<0.05), except mild SUI group and moderate SUI group.4. The comparisons of dynamic MRI evaluation indicator measurements reflecting the degree of plevic floor weakness among control group, mild SUI group, moderate SUI group and severe SUI groupThe length of H line:(1)The static or dynamic measurement:The average from low to high was control group, mild SUI group, moderate SUI group and severe SUI group. There was a significant difference between any two groups(P<0.05), except mild SUI group and moderate SUI group.(2) The D-value between rest and straining: The average from low to high was control group, mild SUI group, moderate SUI group and severe SUI group. There was a significant difference between any two groups(P<0.05), except control group and mild SUI group, mild SUI group and moderate SUI group.The length of M line:(1)The static measurement:The average from low to high was control group, mild SUI group, moderate SUI group and severe SUI group. There was a significant difference between any two groups(P<0.05), except mild SUI group and moderate SUI group.(2)The dynamic measurement:The average from low to high was control group, mild SUI group, moderate SUI group and severe SUI group. There was a significant difference between any two groups(P<0.05).(3) The D-value between rest and straining:The average from low to high was control group, mild SUI group, moderate SUI group and severe SUI group. There was a significant difference between any two groups(P<0.05), except control group and mild/moderate SUI group, mild SUI group and moderate SUI group.Bladder neck to PCL:The static/dynamic measurement or D-value between rest and straining:The average from low to high was control group, mild SUI group, moderate SUI group and severe SUI group. There was a significant difference between any two groups(P<0.05).Cervix to PCL:(1)The static measurement or D-value between rest and straining: The average from low to high was control group, mild SUI group, moderate SUI group and severe SUI group. There was a significant difference between any two groups(P<0.05), except control group and mild SUI group, mild SUI group and moderate SUI group.(2) The dynamic measurement:The average from low to high was control group, mild SUI group, moderate SUI group and severe SUI group. There was a significant difference between any two groups(P<0.05).The border between anus and rectum to MPL:The static/dynamic measurement or D-value between rest and straining:There was no significant difference between any two groups(P>0.05).Conclusion1. Urethral length、the length of M line、the transverse diameter of pelvic diaphragm hiatus、bladder neck to PCL and cervix to PCL were helpful to distinguish the mild moderate and severe SUI. Among them, bladder neck to PCL is most meaningful indicator. Posterior vesicourethral angle、urethral inclination angle、retropubic space、 levator plate angle、the length of H line had limited usefulness for the grading of SUI. The thickness of puborectalis、the border between anus and rectum to MPL has little meaningful for the grading of SUI.2. The measurement of dynamic MRI evaluation indicators of pelvic floor might have some clinical value in evaluating the severity of female SUI.