Clinical value of dynamic MRI of vaginal and rectal with coupling agent in the diagnosis of prolapse and rectocele

Objective: To investigate the diagnostic value of dynamic MRI with coupling agent filled vaginal and rectum in the display of vaginal vault prolapse and rectocele. Methods: Thirty three female patients, who were diagnosed with pelvic organ prolapse with H degrees and above by gynecologic outpatient clinic and prepared to be treated with surgery were prospectively collected. All of them underwent two types of dynamic MRI, one was routine dynamic MRI (Group A) and the other was dynamic MRI with vaginal and rectum filled with coupling agent (Group B). Two radiologists evaluated and scored the display of vaginal vault and rectocele on these two groups of dynamic MRI images. According to the joint result of two radiologists, two gynecologists made surgical planning. Kappa test was used to compare the consistency of scores performed by two radiologists, and Fisher exact test was used to compare the differentiation from both groups, as well as the differentiation of probability of high uterosacral ligament suspension. Results: The Kappa value of both groups was 0.65 and 1.00 respectively, where the consistency of Group B was superior than Group A. There were significant differences between the two groups(P < 0.01), where Group B was better than Group A. Based on the imaging results of Group A, 7 patients (21.2%, 7/33) were decided to make high uterosacral ligament suspension. Based on the imaging results of Group B, 20 patients (60.6%, 20/33) were decided to make high uterosacral ligament suspension, and differences were statistical significance between the two groups(P < 0.05). Conclusions: For purpose of the displaying vaginal vault and rectocele, the dynamic MR imaging with vaginal and rectum filled with coupling agent was better than routine method. The proposed method can provide important information and reference for the establishment of surgical planning. (authors)