A Magnetic Resonance Imaging (MRI) Measure of Intramuscular Fat in Pelvic Floor Musculature of Nulliparous Women

Laura La Porta Krum PT, PhD, OCS Angie Mueller SPT Eric Utes SPT Meghan Adams-Jorg SPT Katie Anderson SPT Kristin Johnson SPT Layna Shorter SPT James Elliott PT, PhD

Role of the Pelvic Floor
• • • • Supports the pelvic organs Contributes to urinary and fecal continence Assists in lumbopelvic stability Contributes to sexual arousal and performance

Background Purpose

Methods

Results

Conclusion

Pathologies of Pelvic Floor Dysfunction
• Urinary incontinence
Gynecol. 2000) Gynecol. 2006)

– 37.4% greater in primiparous women

(MacLennan, et al. Br J Obstet (Altman et al. Obstet

– 5-6 times more likely with vaginal delivery – Reported by 25-75% women postpartum
Obstet Gynecol. 2004)

(Gregory, & Nygaard. Clininal

• Pelvic Organ Prolapse
Obstet Gynecol. 1999)

– Parity increases risk (Buchsbaum et al. Obstet Gynecol. 2006) – Found in 44% of parous women aged 20-59

(Samuelsson et al. Am J

• Dyspareunia

– Pelvic floor muscle spasm and/or scar tissue following an episiotomy (MacLennan et al. Br J Obstet Gynecol. 2000)
Methods Results Conclusion

Background Purpose

Research Question
Can a novel MR imaging technique be developed that is sensitive enough to identify markers of pelvic floor damage?

Key Studies: Elliott et al. (2006)
• Quantification of intramuscular fat using signal intensity from T1 weighted MRI images
– Muscle/Fat Index
Elliot J et al. Spine. 2006;22:E847E855

Background Purpose

Methods

Results

Conclusion

MRI Measure

Pixel Intensity Profile

www.mricro.com
Rorden, 2000

Key Studies: Margulies et al. (2006)
• 80 nulliparous women with normal pelvic support • Described 5 levator ani subdivisions using T2 weighted axial, coronal, and sagittal MRI scan planes
– Pubovisceral (puboanal, puboperineal, pubovaginal) – Puborectal – Illiococcygeal

• Pubovisceral (PV) selected as muscle region of interest

Background Purpose

Methods

Results

Conclusion

Key Studies

Margulies R et al. Obstet Gynecol. 2006;107:1064–9

Pilot a reliable anddata in future to Use normative valid method comparative studies constituents in the quantify muscle/fat investigating pelvic floor muscle muscles of asymptomatic pelvic floor changes following vaginal birth and cesareanfemales. nulliparous adult delivery.

Background Purpose

Methods

Results

Conclusion

Participants
• 20-40 yr old females (N=8) • Inclusion Criteria
– Caucasian, nulliparous

• Exclusion Criteria
– Hx of PFD

Background Purpose

Methods

Results

Conclusion

Procedures
• Informed consent • Outcome Measures
– QUID, IIQ-7, I-QOL, RADL, PDI

• • • • •

Weight Height Body fat Manometry MRI

Background Purpose

Methods

Results

Conclusion

MRI Measures
• PV and Obteratur Internus (OI) measured at the level of the proximal and middle urethra
Proximal Urethra

Background Purpose

Methods

Results

Conclusion

Middle Urethra

Background Purpose

Methods

Results

Conclusion

Region of Interest

Background Purpose

Methods

Results

Conclusion

Data Analysis
Region of Interest (ROI) converted into scaled intensity profile (min/mean/max) per muscle

Background Purpose

Methods

Results

Conclusion

Reliability
Level Selection • ICC (2,1) = 1.0
(Interrater)

Muscle ROI • ICC (2,1) = 1.0
(Interrater)

• ICC (3,1) = .92
(Intrarater)

• ICC (3,1) = 1.0
(Intrarater)

Background Purpose

Methods

Results

Conclusion

Mean muscle ~ .11 + .02 11% Mean fat SI SI

Clear to Proceed!
• Establish normative data • Use to identify pelvic floor muscle change due to pregnancy (post cesarean) and post-vaginal delivery

Background Purpose

Methods

Results

Conclusion

Future Research
• Relationship of signal intensity changes of pelvic floor muscles
– Pain – Pelvic floor dysfunction – Quality of life measures in symptomatic and/or postpartum women

• Develop diagnostic markers for early detection and/or treatment

Background Purpose

Methods

Results

Conclusion

Research Support
• Regis University SPARC Award • The University of Queensland, Australia- Post-Doctoral Research Funds