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MR-Based Three-Dimensional Modeling of the Normal Pelvic Floor in Women

Quantification of Muscle Mass

¹ All authors: Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115.

View larger version (135K): [in a new window]   Fig. 1A. —32-year-old healthy female volunteer. Axial T2-weighted MR image of inferior portion of healthy female pelvis. Segmentation markings are manually drawn to surround areas of interest. Width of levator hiatus is measured at level of transverse urethral ligament (straight arrow). Note asymmetry of left and right aspects of puborectalis muscle, outlined in green (curved arrow).

View larger version (119K): [in a new window]   Fig. 1B. —32-year-old healthy female volunteer. Axial T2-weighted MR image slightly cephalad to A shows coccygeus (arrow) and iliococcygeus (arrowhead) muscles, which must be identified on each slice.

View larger version (101K): [in a new window]   Fig. 2. —28-year-old healthy female volunteer. Oblique coronal three-dimensional model shows female pelvis Color rendering of pelvic floor muscles allows accurate delineation of morphology and volume assessment o levator ani, which includes puborectalis, iliococcygeus, and coccygeus. Keyhole shape indicates normal sepa ration of vagina and rectum and intact perineal body.

View larger version (110K): [in a new window]   Fig. 3A. —24-year-old healthy female volunteer. Color scheme: white = bones, pink = levator ani, yellow = bladder and urethra, blue = vagina, green = uterus, gray = rectum. Dorsal lithotomy view of three-dimensional (3D) model shows healthy female pelvis. Model was created with software developed in house. This software allows super-imposition of gray-scale source images on 3D models in corresponding anatomic locations. View mimics that used by gynecologists when examining patients or performing surgery. Arcus tendineus fasciae (arrowheads), known by gynecologists as white line of pelvis, is commonly disrupted in women with pelvic organ prolapse. Boundaries of levator hiatus are delineated by stars.

View larger version (85K): [in a new window]   Fig. 3B. —24-year-old healthy female volunteer. Color scheme: white = bones, pink = levator ani, yellow = bladder and urethra, blue = vagina, green = uterus, gray = rectum. Lateral view of same 3D model as in A shows pubococcygeal line drawn between tip of coccyx and inferior aspect of symphysis pubis. In healthy women, bladder base (arrow) rests above pubococcygeal line, and levator plate (arrowheads) is parallel to pubococcygeal line. Descent of bladder base or caudal inclination of levator plate indicates pelvic floor laxity.

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