Krum CSM Presentation 2010

8/14/2019 Krum CSM Presentation 2010

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A Magnetic Resonance Imaging(MRI) Measure of Intramuscular Fat

in Pelvic Floor Musculature ofNulliparous Women

Laura La Porta Krum PT, PhD, OCSAngie Mueller SPT

Eric Utes SPT

Meghan Adams-Jorg SPTKatie Anderson SPTKristin Johnson SPTLayna Shorter SPT

James Elliott PT, PhD


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Supports the pelvic organs

Contributes to urinary and fecal continence

Assists in lumbopelvic stability

Contributes to sexual arousal and performance

Role of the Pelvic Floor

Background Purpose Methods Results Conclusion


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Urinary incontinence 37.4% greater in primiparous women (MacLennan, et al. Br J Obstet

Gynecol. 2000)

5-6 times more likely with vaginal delivery (Altman et al. ObstetGynecol. 2006)

Reported by 25-75% women postpartum (Gregory, & Nygaard. ClininalObstet Gynecol. 2004)

Pelvic Organ Prolapse Parity increases risk (Buchsbaum et al. Obstet Gynecol. 2006) Found in 44% of parous women aged 20-59 (Samuelsson et al. Am J

Obstet Gynecol. 1999)

Dyspareunia Pelvic floor muscle spasm and/or scar tissue following an

episiotomy (MacLennan et al. Br J Obstet Gynecol. 2000)

Pathologies of Pelvic FloorDysfunction



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Research Question

Can a novel MR imagingtechnique

be developed that is sensitive

enough to identify markers ofpelvic floor damage?


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Quantification of intramuscular fatusing signal intensity from T1weighted MRI images

Muscle/Fat IndexElliot J et al. Spine. 2006;22:E847-

E855

Key Studies: Elliott et al.(2006)



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www.mricro.com

Rorden, 2000

MRI Measure

Pixel Intensity Profile
http://www.mricro.com/http://www.mricro.com/


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Key Studies: Margulies et al.(2006)

80 nulliparous women with normal pelvic support

Described 5 levator ani subdivisions using T2 weightedaxial, coronal, and sagittal MRI scan planes Pubovisceral (puboanal, puboperineal, pubovaginal)

Puborectal

Illiococcygeal

Pubovisceral (PV) selected as muscle region ofinterest



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Key Studies

Margulies R et al. Obstet Gynecol.2006;107:10649


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Use normative data in futurecomparative studies investigating pelvic

floor muscle changes following vaginalbirth and cesarean delivery.


Pilot a reliable and valid method toquantify muscle/fat constituents in the

pelvic floor muscles of asymptomaticnulliparous adult females.


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20-40 yr old females (N=8)

Inclusion Criteria

Caucasian, nulliparous

Exclusion Criteria

Hx of PFD

Participants



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Procedures

Informed consent

Outcome Measures

QUID, IIQ-7, I-QOL,

RADL, PDI Weight

Height

Body fat

Manometry

MRI



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MRI Measures

PV and Obteratur Internus (OI) measured at thelevel of the proximal and middle urethra

Proximal Urethra



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Middle Urethra



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Region of Interest



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Data Analysis

Region of Interest (ROI) converted into scaledintensity profile (min/mean/max) per muscle



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Reliability

Level Selection

ICC (2,1) = 1.0 (Interrater)

ICC (3,1) = .92(Intrarater)

Muscle ROI

ICC (2,1) = 1.0 (Interrater)

ICC (3,1) = 1.0(Intrarater)



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Mean muscle

SIMean fat

SI

~ .11 + .0211%


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Establish normative data

Use to identify pelvic floor musclechange due to pregnancy (postcesarean) and post-vaginal delivery

Clear to Proceed!



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Future Research

Relationship of signal intensity changes of pelvic floormuscles

Pain

Pelvic floor dysfunction

Quality of life measures in symptomatic and/or postpartum

women

Develop diagnostic markers for early detection and/ortreatment



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Research Support

Regis University SPARC Award

The University of Queensland,Australia- Post-Doctoral ResearchFunds

Krum CSM Presentation 2010

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