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ECR 2018 / C-0529
Is MRI the gold standard imaging technique to diagnose levator ani muscle avulsion?
Congress: ECR 2018
Poster No.: C-0529
Type: Scientific Exhibit
Keywords: Genital / Reproductive system female, Anatomy, Obstetrics (Pregnancy / birth / postnatal period), MR, Ultrasound, Computer Applications-3D, Imaging sequences, Obstetrics, Pelvic floor dysfunction
Authors: I. van Gruting1, A. Stankiewicz2, A. Sultan1, R. Thakar1; 1London/UK, 2Lublin/PL



Mean age was 34.8 (SD 5.5) years, BMI 26.5 (SD 6.0) and parity 1.5 (SD 0.6). Time after first delivery was 3.8 (0.4 SD) years. Time between US and MRI was 21 (SD 49) days. On MRI 23 (17%) had a minor and 3 (2%) a major LAM avulsion. Both TPUS and EVUS showed a poor sensitivity (26-39%) for minor LAM avulsion and an excellent sensitivity (100%) for major LAM avulsion (Table 1). Specificity was excellent (93-97%) for both US techniques for minor and major LAM avulsion. Both US techniques identified all major LAM avulsions seen on MRI and identified an additional 13 (EVUS 6, TPUS 4, both 3). In contrast, all three imaging techniques agreed in only 4 of the 23 minor LAM avulsions found on MRI. TPUS agreed in 6, missed 12, classified 5 as major and found 3 additional minor LAM avulsions. EVUS agreed in 9, missed 10, classified 4 as major and found 7 additional minor LAM avulsions.


LAM avulsion on MRI did not correlate with any symptoms, but minor avulsion was associated with a reduction in PFMS (p=0.004). Women with minor LAM avulsion on EVUS had more symptoms of stress urinary incontinence (p=0.007) and POP (p=0.039). Women with minor and major LAM avulsion on EVUS had reduced PFMS (p= 0.037, p=0.021). Major LAM avulsion on EVUS correlated with cystocele grade ≥ 2 (p=0.013) on clinical examination. Minor or major LAM avulsion on TPUS did not correlate with any symptoms of PFD, but did correlate with reduced PFMS (p=0.000, p=0.025).


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