Feasibility of diffusion tensor imaging (DTI) with fibre tractography of the normal female pelvic floor

• Published in: European radiology 2011-06, Vol.21 (6), p.1243-1249
• Main Authors: Zijta, F. M., Froeling, M., van der Paardt, M. P., Lakeman, M. M. E., Bipat, S., Montauban van Swijndregt, A. D., Strijkers, G. J., Nederveen, A. J., Stoker, J.
• Format: Article
• Language: English
• Subjects: Adult; Algorithms; Biomedical engineering; Diagnostic Radiology; Diffusion Tensor Imaging - methods; Eigenvalues; Feasibility; Feasibility Studies; Female; Humans; Image Enhancement - methods; Image Interpretation, Computer-Assisted - methods; Imaging; Imaging, Three-Dimensional - methods; Internal Medicine; Interventional Radiology; Magnetic Resonance; Magnetic resonance imaging; Medicine; Medicine & Public Health; Muscle Fibers, Skeletal - cytology; Neuroradiology; Pelvic Floor - anatomy & histology; Pelvis; Radiology; Reference Values; Reproducibility of Results; Sensitivity and Specificity; Software; Ultrasound
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-010-2044-8

Objectives To prospectively determine the feasibility of diffusion tensor imaging (DTI) with fibre tractography as a tool for the three-dimensional (3D) visualisation of normal pelvic floor anatomy. Methods Five young female nulliparous subjects (mean age 28 ± 3 years) underwent DTI at 3.0T. Two-dimensional diffusion-weighted axial spin-echo echo-planar (SP-EPI) pulse sequence of the pelvic floor was performed, with additional T2-TSE multiplanar sequences for anatomical reference. Fibre tractography for visualisation of predefined pelvic floor and pelvic wall muscles was performed offline by two observers, applying a consensus method. Three eigenvalues (λ1, λ2, λ3), fractional anisotropy (FA) and mean diffusivity (MD) were calculated from the fibre trajectories. Results In all subjects fibre tractography resulted in a satisfactory anatomical representation of the pubovisceral muscle, perineal body, anal - and urethral sphincter complex and internal obturator muscle. Mean FA values ranged from 0.23 ± 0.02 to 0.30 ± 0.04, MD values from 1.30 ± 0.08 to 1.73 ± 0.12 × 10 − ³ mm²/s. Muscular structures in the superficial layer of the pelvic floor could not be satisfactorily identified. Conclusions This study demonstrates the feasibility of visualising the complex three-dimensional pelvic floor architecture using 3T-DTI with fibre tractography. DTI of the deep female pelvic floor may provide new insights into pelvic floor disorders.