Dynamic pelvic floor imaging: MRI techniques and imaging parameters

Magnetic resonance imaging (MRI) is an excellent tool to understand the complex anatomy of the pelvic floor and to assess pelvic floor disorders. MRI enables static and dynamic imaging of the pelvic floor. Using static T2-weighted sequences the morphology of the pelvic floor can be visualized in great detail. A rapid half-Fourier T2-weighted, balanced steady state free precession, or gradient-recalled echo sequence are used to obtain sagittal images while the patient is at rest, during pelvic squeeze, during pelvic strain and to document the evacuation process. On these images the radiologist identifies the pubococcygeal line (PCL) (which represents the level of the pelvic floor). In normal findings, the base of the anterior and the middle compartment are above the PCL at rest, and the pelvic floor elevates during contraction. During straining the pelvic floor muscles should relax and the pelvic floor descends normally less than 3 cm below the PCL. Pelvic floor MRI based on the static and dynamic MRI sequences allows for the detection and characterization of a vast array of morphologic and functional pelvic floor disorders. In this review, we focus on technical aspects of static and dynamic pelvic floor MRI