基于静动态磁共振成像比较正常青年男女盆底解剖结构及功能特征的差异

doi:10.13418/j.issn.1001-165x.2023.2.05

摘要/Abstract

摘要： 目的利用静动态盆底磁共振成像技术比较正常青年男女盆底解剖结构及功能特征的差异。方法前瞻性收集健康青年志愿者男性60例，女性60例，使用3.0T MRI扫描仪行静态动态盆底MRI扫描。在静态及动态最大力排相矢状位T2WI图像上测量H线、M线、膀胱颈（bladder neck，BN）到耻骨尾骨线（pubococcygeal line，PCL）线的垂直距离（BN-PCL）、子宫（uterus）到PCL线的垂直距离（U-PCL）、肛管直肠角、肛提肌板角、耻骨前列腺角，并计算上述参数静动态差值；在静态横轴位T2WI图像上测量耻骨直肠肌厚度和髂尾肌厚度。比较各参数两组间差异。结果正常青年男性静态M线长度、静态及动态最大力排相BN-PCL线长度明显大于女性（P<0.05）；男性髂尾肌厚度明显大于女性（P<0.05）；女性H线、BN-PCL线静动态差值明显大于男性（P<0.05）。结论静动态盆底MRI发现男性和女性肛直肠交界处、膀胱颈位置及盆底支持结构存在差异，提示临床医生利用磁共振技术评估盆底解剖结构及功能时应关注性别、个体差异，以提高盆底功能障碍性疾病的有效治愈率。郑州大学第一附属医院 1.磁共振科， 2.泌尿外科，郑州 450052

关键词: 静动态磁共振； , , 盆底； , , 解剖学； , , 正常青年； , , 性别

Abstract: Objective To compare the differences of anatomical parameters of pelvic floor between normal young men and women by static and dynamic pelvic floor magnetic resonance imaging. Methods Sixty male and sixty female healthy young volunteers were prospectively collected. All volunteers underwent static and dynamic pelvic floor MRI with 3.0T MRI scanners. The length of H line, the length of M line, the vertical distance from bladder neck (BN) to pubococcygeal line (PCL line) (BN-PCL), the vertical distance from uterus to PCL line (U-PCL), anorectal angle (ARA), levator ani plate angle (LPA), puboprostatic angle (PPA) were measured on static and dynamic maximum force phase sagittal T2WI images, and the static and dynamic differences of the above parameters were calculated. The thickness of puborectal muscle (PRM) and iliococcygeal muscle (ICM) were measured on static axial T2WI images. The differences of the parameters between the two groups were compared whether there was statistical significance or not. Results The static M line length, static and dynamic maximum force phase BN-PCL line length of normal young male were significantly longer than that of female (P<0.05); the thickness of iliococcygeal muscle in male was significantly higher than that in female (P<0.05); by comparing the changes of parameters in the two states, the length changes of H line and BN-PCL line in female were significantly greater than those in male (P<0.05). Conclusions Static and dynamic MRI shows that there are difference in anorectal junction, bladder neck position and pelvic floor supporting structure between men and women, suggesting that clinicians should pay attention to gender and individual differences when evaluating the anatomical structure and function of pelvic floor by magnetic resonance imaging, so as to improve the effective cure rate of pelvic floor dysfunctional diseases (PFD).

Key words: Static and dynamic magnetic resonance imaging; , , Pelvic floor; , , Anatomy; , , Normal youth; , , Gender

中图分类号:

R445.2

赵志恒, 吴玥, 张静, 杨子涛, 张钦涌, 王庆伟, 程敬亮, 车英玉. 基于静动态磁共振成像比较正常青年男女盆底解剖结构及功能特征的差异[J]. 中国临床解剖学杂志, 2023, 41(2): 143-149.

Zhao Zhiheng, Wu Yue, Zhang Jing, Yang Zitao, Zhang Qinyong, Wang Qingwei, Cheng Jingliang , Che Yingyu. Comparative study of anatomical structure and functional characteristics of pelvic floor in normal young men and women by static and dynamic magnetic resonance imaging[J]. Chinese Journal of Clinical Anatomy, 2023, 41(2): 143-149.

参考文献 25

[1]	Lakhoo J, Khatri G, El sayed RF, et al. MRI of the male pelvic floor[J]. Radiographics, 2019, 39(7): 2003-2022. DOI: 10.1148/rg.2019190064.
[2]	Sheth VR, Duran P, Wong J, et al. Multimodal imaging assessment and histologic correlation of the female rat pelvic floor muscles' anatomy[J]. J Anat, 2019, 234(4): 543-550. DOI: 10.1111/joa.12943.
[3]	El sayed RF. Magnetic resonance imaging of the female pelvic floor: anatomy overview, indications, and imaging protocols[J]. Radiol Clin North Am, 2020, 58(2): 291-303. DOI: 10.1016/j.rcl.2019.11.005.
[4]	Zhang H, Wang Z, Xiao X, et al. Dynamic magnetic resonance imaging evaluation before and after operation for pelvic organ prolapse[J]. Abdom Radiol (NY), 2022, 47(2): 848-857. DOI: 10.1007/s00261-021-03361-9.
[5]	李志毅, 吴玲, 郎景和, 等. 中国城市地区女性盆腔器官脱垂临床流行病学调查[J]. 中华医学杂志, 2019, 99(11): 5. DOI: 10.3760/cma.j.issn.0376-2491.2019.11.012.
[6]	Schiano di Visconte M, Azzena A. A 10-year retrospective cohort study to assess objective and subjective outcomes of combined stapled transanal rectal resection and urogynecological surgery for pelvic floor dysfunction[J]. Arch Gynecol Obstet, 2020, 302(2): 393-404. DOI: 10.1007/s00404-020-05605-3.
[7]	Gurland BH, Khatri G, Ram R, et al. Consensus definitions and interpretation templates for magnetic resonance imaging of defecatory pelvic floor disorders: proceedings of the consensus meeting of the pelvic floor disorders consortium of the american society of colon and rectal surgeons, the society of abdominal radiology, the international continence society, the american urogynecologic society, the international urogynecological association, and the society of gynecologic surgeons[J]. Dis Colon Rectum, 2021, 64(10): 1184-1197. DOI: 10.1097/DCR.0000000000002155.
[8]	Laura G, Jaime D, Felipe A, et al. MR imaging-based assessment of the female pelvic floor[J]. Radiographics, 2014, 34(5): 1417-1439. DOI: 10.1148/rg.345140137.
[9]	Goh V, Halligan S, Kaplan G, et al. Dynamic MR imaging of the pelvic floor in asymptomatic subjects[J]. AJR Am J Roentgenol, 2000, 174(3): 661-666. DOI: 10.2214/ajr.174.3.1740661.
[10]	吴玥, 朱文, 王庆伟, 等. 基于盆底MRI评估年龄与前列腺癌根治术对男性盆底解剖结构及尿控的影响[J]. 临床泌尿外科杂志, 2021, 36(10): 7. DOI: 10.13201/j.issn.1001-1420.2021.10.003.
[11]	华冰. PFD患者及正常女性盆底解剖结构的MRI研究[J]. 中国CT和MRI杂志, 2015(5): 114-116. DOI: 10.3969/j.issn.1672-5131. 2015. 05. 035.
[12]	颜惠华, 楼征, 张卫, 等. 骨盆径线CT测量方法[J]. 中华胃肠外科杂志, 2011,14(4): 291-292. DOI: 10.3760/cma.j.issn.1671-0274. 2011. 04.019.
[13]	Horosz E, Pomian A, Zwierzchowska A, et al. Epidemiological features of the bladder neck rest position and mobility[J]. J Clin Med, 2020, 9(8): 2413. DOI: 10.3390/jcm9082413.
[14]	Narita K, Yamada Y, Yamada M, et al. Pelvic floor morphology in the standing position using upright computed tomography: age and sex differences[J]. Int Urogynecol J, 2020, 31(11): 2387-2393. DOI: 10.1007/s00192-020-04335-z.
[15]	中华医学会放射学分会MR学组. 女性盆底功能障碍性疾病的MRI技术与报告规范[J]. 中华放射学杂志, 2022, 56(1): 16-24. DOI: 10.3760/cma.j.cn112149-20210426-00412.
[16]	Shafik A. A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. VIII. Levator hiatus and tunnel: anatomy and function[J]. Dis Colon Rectum, 1979, 22(8): 539-549. DOI: 10.1007/BF02587000.
[17]	Cho ST, Kim KH. Pelvic floor muscle exercise and training for coping with urinary incontinence[J]. J Exerc Rehabil, 2021, 17(6): 379-387. DOI: 10.12965/jer.2142666.333.
[18]	Li D, Guo M. Morphology of the levator ani muscle[J]. Dis Colon Rectum, 2007, 50(11): 1831-1839. DOI: 10.1007/s10350-007-0265-y.
[19]	Barberio B, Judge C, Savarino EV, et al. Global prevalence of functional constipation according to the Rome criteria: a systematic review and meta-analysis[J]. Lancet Gastroenterol Hepatol, 2021, 6(8): 638-648. DOI: 10.1016/S2468-1253(21)00111-4.
[20]	Chamié LP, Ribeiro DMFR, Caiado AHM, et al. Translabial US and dynamic MR imaging of the pelvic floor: normal anatomy and dysfunction[J]. Radiographics, 2018, 38(1): 287-308. DOI: 10.1148/rg.2018170055.
[21]	Tirumanisetty P, Prichard D, Fletcher JG, et al. Normal values for assessment of anal sphincter morphology, anorectal motion, and pelvic organ prolapse with MRI in healthy women[J]. Neurogastroenterol Motil, 2018, 30(7): e13314. DOI: 10.1111/nmo.13314.
[22]	Schreyer AG, Paetzel C, Fürst A, et al. Dynamic magnetic resonance defecography in 10 asymptomatic volunteers[J]. World J Gastroenterol, 2012, 18(46): 6836-6842. DOI: 10.3748/wjg.v18.i46.6836.
[23]	赵亚婧, 潘晓晔, 张轶, 等. 3D高分辨率肛门直肠测压技术对盆底痉挛综合征的诊断价值[J]. 天津医科大学学报, 2018, 24(3): 5. CNKI: SUN:TJYK.0.2018-03-015.
[24]	Ozasa H, Mori T, Togashi K. Study of uterine prolapse by magnetic resonance imaging: topographical changes involving the levator ani muscle and the vagina[J]. Gynecol Obste Invest, 1992, 34(1): 43-48. DOI: 10.1159/000292723.
[25]	Hocaoglu Y, Roosen A, Herrmann K, et al. Real-time magnetic resonance imaging (MRI): anatomical changes during physiological voiding in men[J]. BJU Int, 2012, 109(2): 234-239. DOI: 10.1111/j.1464-410X.2011.10255.x.