Evaluation of the female pelvic floor in pelvic organ prolapse using 3.0-Tesla diffusion tensor imaging and fibre tractography

F. M. Zijta*, M. M. E. Lakeman, M. Froeling, M. P. van der Paardt, C. S. V. Borstlap, S. Bipat, A. D. Montauban van Swijndregt, G. J. Strijkers, J. P. Roovers, A. J. Nederveen, J. Stoker

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objectives To prospectively explore the clinical application of diffusion tensor imaging (DTI) and fibre tractography in evaluating the pelvic floor.

Methods Ten patients with pelvic organ prolapse, ten with pelvic floor symptoms and ten asymptomatic women were included. A two-dimensional (2D) spin-echo (SE) echo-planar imaging (EPI) sequence of the pelvic floor was acquired. Offline fibre tractography and morphological analysis of pelvic magnetic resonance imaging (MRI) were performed. Inter-rater agreement for quality assessment of fibre tracking results was evaluated using weighted kappa (kappa). From agreed tracking results, eigen values (lambda 1, lambda 2, lambda 3), mean diffusivity (MD) and fractional anisotropy (FA) were calculated. MD and FA values were compared using ANOVA. Inter-rater reliability of DTI parameters was interpreted using the intra-class correlation coefficient (ICC).

Results Substantial inter-rater agreement was found (kappa = 0.71 [95% CI 0.63-0.78]). Four anatomical structures were reliably identified. Substantial inter-rater agreement was found for MD and FA (ICC 0.60-0.91). No significant differences between groups were observed for anal sphincter, perineal body and puboperineal muscle. A significant difference in FA was found for internal obturator muscle between the prolapse group and the asymptomatic group (0.27 +/- 0.05 vs 0.22 +/- 0.03; P = 0.015).

Conclusion DTI with fibre tractography permits identification of part of the clinically relevant pelvic structures. Overall, no significant differences in DTI parameters were found between groups.

Original languageEnglish
Pages (from-to)2806-2813
Number of pages8
JournalEuropean Radiology
Issue number12
Publication statusPublished - Dec 2012


  • Magnetic resonance imaging (MRI)
  • Diffusion tensor imaging (DTI)
  • Pelvic floor disorders
  • Fibre tractography
  • Pelvic floor
  • MRI


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