Validation of Two Dimensional Perineal Ultrasound and Dynamic Magnetic Resonance Imaging in Pelvic floor Dysfunction.

Pelvic floor dysfunctions are complex conditions which commonly affects the elderly women. The pelvic floor dysfunction includes defect of anterior, middle and posterior compartment which includes cystocele,uterine descent and rectocele. MRI has been used for imagingfemale pelvic floor in preoperative planning of complicated cases.Recently perineal ultrasonography is gaining importance in imaging of pelvic floor. There are many shared advantages of the two imaging modalities namely 1. No ionizing radiation 2. Non invasive 3. Superior soft tissue contrast Apart from the above mentioned combined advantages, transperineal ultrasound scores overin the aspect of cost effectiveness and repeatability as well as reproducibility of the examinationwhich can be performed in an outpatient clinic.However MRI is superior in imaging largevolume of pelvis. CONCLUSION : 1.There were no significant difference between transperineal ultrasound and dynamic Magnetic resonance imaging in measuring the bladder base below PCL line while at rest and during valsalva. Transperineal ultrasound has positive correlation with dynamicmagnetic resonance imaging in measuring the the descent of the bladder base below the PCL line. 2.Transperineal ultrasound is equally as effective as dynamic magnetic resonance imaging in measuring the descent of the uterus below the PCL line while doing the procedure at rest and during valsalva. 3.Transperineal ultrasound is equally as effective as dynamic Magnetic resonanceimaging in measuring the “ H” line while doing the procedure at rest and during valsalva.There were no significant difference between transperineal ultrasound and dynamic magnetic resonance imaging in measuring “H”line while doing the procedure at rest and duringvalsalva. 4.Transperineal ultrasound is equally as effective as dynamic magnetic resonance imaging in assessing the anal sphincter integrity. 5.Transperineal ultrasound is an accessible tool to assess the occult sphincter defect in patients without history of fecal incontinence. 6.Hence Transperineal ultrasound has significant positive correlation with above four parameters in comparison with gold standard dynamic Magnetic resonance imaging in measuring pelvic floor dysfunction ,Transperineal ultrasound can be used as screening tool to evaluate women with pelvic floor dysfunction. Women found to have pelvic floor dysfunction by transperineal ultrasound who needs surgical intervention can be confirmed with gold standard dynamic magnetic resonance imaging. 7.Hence transperineal ultrasound is cost effective, no radiation, reproducible, non invasive investigation modality ,which can be used as a screening tool for all women withpelvic floor weakness. 8.The limitation of transperineal ultrasound is measuring the length of bladder base below PCL line,uterus below PCL line, and “H”line in patients with pelvic floor weakness during valsalva.MRI detects the abnormal length (>2cm) accurately.In treatmentpoint of view the length in centimeter is very important but Transperineal ultrasound detects the abnormality but accuracy of length could not be ascertained. So Transperineal ultrasound can be used as screening tool for evaluation of women with various pelvic floor dysfunction