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Using stress MRI to analyze the 3D changes in apical ligament geometry from rest to maximal Valsalva: a pilot study

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Abstract

Introduction and hypothesis

A method was developed using 3D stress magnetic resonance imaging (MRI) and was piloted to test hypotheses concerning changes in apical ligament lengths and lines of action from rest to maximal Valsalva.

Methods

Ten women with (cases) and ten without (controls) pelvic organ prolapse (POP) were selected from an ongoing case–control study. Supine, multiplanar stress MRI was performed at rest and at maximal Valsalva and was imported into 3D Slicer v. 3.4.1 and aligned. The 3D reconstructions of the uterus and vagina, cardinal ligament (CL), deep uterosacral ligament (USLd), and pelvic bones were created. Ligament length and orientation were then measured.

Results

Adequate ligament representations were possible in all 20 study participants. When cases were compared with controls, the curve length of the CL at rest was 71 ±16 mm vs. 59 ± 9 mm (p = 0.051), and the USLd was 38 ± 16 mm vs. 36 ± 11 mm (p = 0.797). Similarly, the increase in CL length from rest to strain was 30 ± 16 mm vs. 15 ± 9 mm (p = 0.033), and USLd was 15 ± 12 mm vs. 7 ± 4 mm (p = 0.094). Likewise, the change in USLd angle was significantly different from CL (p < 0.001).

Conclusions

This technique allows quantification of 3D geometry at rest and at strain. In our pilot sample, at maximal Valsalva, CL elongation was greater in cases than controls, whereas USLd was not; CL also exhibited greater changes in ligament length, and USLd exhibited greater changes in ligament inclination angle.

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Acknowledgments

We gratefully acknowledge support from the National Institutes of Health, Office for Research on Women’s Health, Specialized Center of Research: Sex and Gender Factors Affecting Women’s Health, Grant P50 HD 044406, and NIH R01 HD 038665.

Conflicts of interest

Dr. John O. DeLancey and Dr. James A. Ashton-Miller have no directly related conflicts of interest for this study. The University of Michigan received funding from Johnson & Johnson, American Medical Systems, Kimberly-Clark Corporation, Proctor & Gamble, and Boston Scientific Corporation as partial salary support for research unrelated to the topic of this paper. They received an honorarium and travel reimbursement for giving an invited research seminar at Johnson & Johnson.

Dr. Jiajia Luo has no directly related conflicts of interest for this study, but his doctoral studies were partially funded by American Medical Systems and Kimberly Clark Corporation unrelated to the topic of this paper, and he currently receives research support from Boston Scientific Corporation unrelated to the topic of this paper.

Dr. Luyun Chen received research support from American Medical Systems unrelated to the topic of this paper.

Dr. Cornelia Betschart received research support from the Swiss National Science Foundation unrelated to the topic of this paper.

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Authors and Affiliations

  1. Pelvic Floor Research Group, University of Michigan, Ann Arbor, MI, USA

    Jiajia Luo, Cornelia Betschart, Luyun Chen, James A. Ashton-Miller & John O. L. DeLancey

  2. Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA

    Jiajia Luo, Luyun Chen & James A. Ashton-Miller

  3. Department of Gynecology, University Hospital of Zurich, Zurich, Switzerland

    Cornelia Betschart

  4. Division of Gynecology, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA

    Cornelia Betschart & John O. L. DeLancey

  5. Biomechanics Research Laboratory, 2350 Hayward St. GG Brown Building 3212, Ann Arbor, MI, 48109, USA

    Jiajia Luo

Authors
  1. Jiajia Luo
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  2. Cornelia Betschart
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  3. Luyun Chen
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  4. James A. Ashton-Miller
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  5. John O. L. DeLancey
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Correspondence to Jiajia Luo.

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Luo, J., Betschart, C., Chen, L. et al. Using stress MRI to analyze the 3D changes in apical ligament geometry from rest to maximal Valsalva: a pilot study. Int Urogynecol J 25, 197–203 (2014). https://doi.org/10.1007/s00192-013-2211-y

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  • DOI: https://doi.org/10.1007/s00192-013-2211-y

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