Concordance of tomographic ultrasound and multiplanar ultrasound in detecting levator ani muscle injury in patients with pelvic organ prolapse

<div><p>Aim</p><p>To compare the evaluations of evaluate levator ani muscle injury (LAMI) by tomographic ultrasound imaging (TUI) and multiplanar (MP) ultrasound in patients with pelvic organ prolapse (POP).</p><p>Method</p><p>This retrospective analysis studied women who underwent International Continence Society POP quantification examination between October 2015 and June 2016. LAMI was assessed by both TUI and MP ultrasounds. Concordance of these two testing results was analyzed. Their correlations with clinical symptoms were also studied.</p><p>Results</p><p>A total of 135 women were included. All the patients with POP had a minimal LAMI depth ≥ 7 mm. Two examinations, TUI and MP, had satisfactory concordance (<i>k</i> = 0.71, <i>P</i> < 0.01). Depth of LAMI in the coronal plane demonstrated good agreement with TUI scores (<i>r</i> = 0.84; <i>P</i> < 0.01). After controlling for age, BMI, and parity, to have clinically significant POP and POP symptoms, the odds ratios (ORs) for the depth of LAMI in the coronal plane were 1.31 (95% CI 1.19–1.44) and 1.25 (95% CI 1.14–1.36), and for TUI scores were 1.72 (95% CI 1.37–2.17) and 1.63 (95% CI 1.31–2.03). Receiver operating characteristic curve analyses showed a cutoff depth of 7 mm of LAMI yielded a sensitivity of 62% and specificity of 80% for POP symptoms.</p><p>Conclusions</p><p>TUI and MP had satisfactory concordance in detecting LAMI and correlated with clinical symptoms of POP.</p></div

Left image depicts an intact levator ani (LA) muscle on right side (short white arrows) and a left-sided avulsion in coronal plane (long white arrows), and the measurement of the levator ani muscle injury (LAMI) depth (long white arrows) above the minimal axial plane in the coronal plane (reference line is the white horizontal line).

<p>Right image depicts levator avulsion on the left side in slices 3–8 on tomographic ultrasound imaging (TUI). TUI score of the right side is 0 and 6 on the left side. P: symphysis pubis.</p

Concordance of tomographic ultrasound and multiplanar ultrasound in detecting levator ani muscle injury in patients with pelvic organ prolapse - Fig 1

<p>Multiplanar mode depicting three orthogonal planes of normal levator ani (LA) insertion: midsagittal plane (top left); coronal plane (top right); and axial plane (bottom left). Determination of the minimal axial plan according to anteroposterior diameter (double-sided arrow) in the midsagittal plane (top left). Image of the intact crescent-shape LA muscles (white arrows) in the coronal plane (top left). P: symphysis pubis.</p