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      Appearance of the levator ani muscle subdivisions on 3D transperineal ultrasound

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          Abstract

          Background

          The levator ani muscle (LAM) consists of different subdivisions, which play a specific role in the pelvic floor mechanics. The aim of this study is to identify and describe the appearance of these subdivisions on 3-Dimensional (3D) transperineal ultrasound (TPUS). To do so, a study designed in three phases was performed in which twenty 3D TPUS scans of vaginally nulliparous women were assessed. The first phase was aimed at getting acquainted with the anatomy of the LAM subdivisions and its appearance on TPUS: relevant literature was consulted, and the TPUS scan of one patient was analyzed to identify the puborectal, iliococcygeal, puboperineal, pubovaginal, and puboanal muscle. In the second phase, the five LAM subdivisions and the pubic bone and external sphincter, used as reference structures, were manually segmented in volume data obtained from five nulliparous women at rest. In the third phase, intra- and inter-observer reproducibility were assessed on twenty TPUS scans by measuring the Dice Similarity Index (DSI).

          Results

          The mean inter-observer and median intra-observer DSI values (with interquartile range) were: puborectal 0.83 (0.13)/0.83 (0.10), puboanal 0.70 (0.16)/0.79 (0.09), iliococcygeal 0.73 (0.14)/0.79 (0.10), puboperineal 0.63 (0.25)/0.75 (0.22), pubovaginal muscle 0.62 (0.22)/0.71 (0.16), and the external sphincter 0.81 (0.12)/0.89 (0.03).

          Conclusion

          Our results show that the LAM subdivisions of nulliparous women can be reproducibly identified on 3D TPUS data.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s13244-021-01037-y.

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          Most cited references34

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          Morphometric analysis of white matter lesions in MR images: method and validation.

          A.P. Zijdenbos, B.M. Dawant, R.A. Margolin … (1994)
          The analysis of MR images is evolving from qualitative to quantitative. More and more, the question asked by clinicians is how much and where, rather than a simple statement on the presence or absence of abnormalities. The authors present a study in which the results obtained with a semiautomatic, multispectral segmentation technique are quantitatively compared to manually delineated regions. The core of the semiautomatic image analysis system is a supervised artificial neural network classifier augmented with dedicated preand postprocessing algorithms, including anisotropic noise filtering and a surface-fitting method for the correction of spatial intensity variations. The study was focused on the quantitation of white matter lesions in the human brain. A total of 36 images from six brain volumes was analyzed twice by each of two operators, under supervision of a neuroradiologist. Both the intra- and interrater variability of the methods were studied in terms of the average tissue area detected per slice, the correlation coefficients between area measurements, and a measure of similarity derived from the kappa statistic. The results indicate that, compared to a manual method, the use of the semiautomatic technique not only facilitates the analysis of the images, but also has similar or lower intra- and interrater variabilities.
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            Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence.

            Lincoln Colling, Jeppe A. Olsen, Robin Smith … (1997)
            To determine the incidence of surgically managed pelvic organ prolapse and urinary incontinence in a population-based cohort, and to describe their clinical characteristics. Our retrospective cohort study included all patients undergoing surgical treatment for prolapse and incontinence during 1995; all were members of Kaiser Permanente Northwest, which included 149,554 women age 20 or older. A standardized data-collection form was used to review all inpatient and outpatient charts of the 395 women identified. Variables examined included age, ethnicity, height, weight, vaginal parity, smoking history, medical history, and surgical history, including the preoperative evaluation, procedure performed, and details of all prior procedures. Analysis included calculation of age-specific and cumulative incidences and determination of the number of primary operations compared with repeat operations performed for prolapse or incontinence. The age-specific incidence increased with advancing age. The lifetime risk of undergoing a single operation for prolapse or incontinence by age 80 was 11.1%. Most patients were older, postmenopausal, parous, and overweight. Nearly half were current or former smokers and one-fifth had chronic lung disease. Reoperation was common (29.2% of cases), and the time intervals between repeat procedures decreased with each successive repair. Pelvic floor dysfunction is a major health issue for older women, as shown by the 11.1% lifetime risk of undergoing a single operation for pelvic organ prolapse and urinary incontinence, as well as the large proportion of reoperations. Our results warrant further epidemiologic research in order to determine the etiology, natural history, and long-term treatment outcomes of these conditions.
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              Prevalence of symptomatic pelvic floor disorders in US women.

              Susan Meikle, Kimberly Kenton, William E Whitehead … (2008)
              Pelvic floor disorders (urinary incontinence, fecal incontinence, and pelvic organ prolapse) affect many women. No national prevalence estimates derived from the same population-based sample exists for multiple pelvic floor disorders in women in the United States. To provide national prevalence estimates of symptomatic pelvic floor disorders in US women. A cross-sectional analysis of 1961 nonpregnant women (>or=20 years) who participated in the 2005-2006 National Health and Nutrition Examination Survey, a nationally representative survey of the US noninstitutionalized population. Women were interviewed in their homes and then underwent standardized physical examinations in a mobile examination center. Urinary incontinence (score of >or=3 on a validated incontinence severity index, constituting moderate to severe leakage), fecal incontinence (at least monthly leakage of solid, liquid, or mucous stool), and pelvic organ prolapse (seeing/feeling a bulge in or outside the vagina) symptoms were assessed. Weighted prevalence estimates of urinary incontinence, fecal incontinence, and pelvic organ prolapse symptoms. The weighted prevalence of at least 1 pelvic floor disorder was 23.7% (95% confidence interval [CI], 21.2%-26.2%), with 15.7% of women (95% CI, 13.2%-18.2%) experiencing urinary incontinence, 9.0% of women (95% CI, 7.3%-10.7%) experiencing fecal incontinence, and 2.9% of women (95% CI, 2.1%-3.7%) experiencing pelvic organ prolapse. The proportion of women reporting at least 1 disorder increased incrementally with age, ranging from 9.7% (95% CI, 7.8%-11.7%) in women between ages 20 and 39 years to 49.7% (95% CI, 40.3%-59.1%) in those aged 80 years or older (P < .001), and parity (12.8% [95% CI, 9.0%-16.6%], 18.4% [95% CI, 12.9%-23.9%], 24.6% [95% CI, 19.5%-29.8%], and 32.4% [95% CI, 27.8%-37.1%] for 0, 1, 2, and 3 or more deliveries, respectively; P < .001). Overweight and obese women were more likely to report at least 1 pelvic floor disorder than normal weight women (26.3% [95% CI, 21.7%-30.9%], 30.4% [95% CI, 25.8%-35.0%], and 15.1% [95% CI, 11.6%-18.7%], respectively; P < .001). We detected no differences in prevalence by racial/ethnic group. Pelvic floor disorders affect a substantial proportion of women and increase with age.
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                Author and article information

                Contributors
                Frieda van den Noort:
                ORCID: http://orcid.org/0000-0002-9998-1229
                f.vandennoort@utwente.nl
                Journal
                Journal ID (nlm-ta): Insights Imaging
                Journal ID (iso-abbrev): Insights Imaging
                Title: Insights into Imaging
                Publisher: Springer International Publishing (Cham )
                ISSN (Electronic): 1869-4101
                Publication date (Electronic): 2 July 2021
                Publication date PMC-release: 2 July 2021
                Publication date Collection: December 2021
                Volume: 12
                Electronic Location Identifier: 91
                Affiliations
                [1 ]GRID grid.7692.a, ISNI 0000000090126352, Department of Obstetrics and Gynecology, , University Medical Centre Utrecht, ; Utrecht, The Netherlands
                [2 ]GRID grid.6214.1, ISNI 0000 0004 0399 8953, Robotics and Mechatronics, , University of Twente, Enschede, ; Carre 3.526, Drienerlolaan 5, 7522NB Enschede, The Netherlands
                [3 ]GRID grid.6214.1, ISNI 0000 0004 0399 8953, Multi-Modality Medical Imaging, Faculty of Science and Technology, Technical Medical Centre, , University of Twente, ; Enschede, The Netherlands
                Author information
                http://orcid.org/0000-0002-9998-1229
                Article
                Publisher ID: 1037
                DOI: 10.1186/s13244-021-01037-y
                PMC ID: 8253870
                PubMed ID: 34213688
                SO-VID: 0d692a33-783d-47d7-8d90-ed5f1bba488c
                Copyright © © The Author(s) 2021
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                Date received : 4 February 2021
                Date accepted : 13 June 2021
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100003958, Stichting voor de Technische Wetenschappen;
                Award ID: 15301
                Award Recipient :
                Categories
                Subject: Original Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2021

                ScienceOpen disciplines: Radiology & Imaging
                Keywords: levator ani muscle,segmentation,transperineal ultrasound,pelvic floor
                Data availability:
                ScienceOpen disciplines: Radiology & Imaging
                Keywords: levator ani muscle, segmentation, transperineal ultrasound, pelvic floor

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