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Is Dynamic True FISP More Accurate than HASTE in Diagnosing Pelvic Floor Dysfunction?

March 26, 2009
Written by: , Filed in: Diagnostic Imaging
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A recent study was conducted to determine if a greater degree of pelvic organ prolapse is evident on the true fast imaging with steady state precession (true FISP) sequence than with the sequential HASTE images.

The study, published in AJR, indicates that dynamic true FISP sequence demonstrated a greater degree of pelvic organ prolapse compared to sequential HASTE sequence in this study.

The Study
59 women with suspected pelvic organ prolapse were evaluated.

Methodology
Examinations were performed on a 1.5-Tesla system. Following localization sequences, sagittal or sagittal oblique true FISP and HASTE sequences were performed.

Sequences were obtained to include the pubic symphysis, urethra, vagina, rectum, and coccyx.

Dynamic images were acquired for both sequences both at rest and at maximal strain.

The images were reviewed by 2 radiologists.

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Diagnostic Imaging Review

The pubococcygeal line was used to grade the presence and degree of pelvic organ prolapse. This was obtained by drawing a line extending from the inferior margin of the pubic symphysis to the inferior most coccygeal joint.

The grading of organ prolapse was based on a perpendicular line drawn from the pubococcygeal line to the inferior margin of the prolapsed organ.

A measurement of <1 cm was graded as negative; 1 to 2 cm was considered mild; 2 to 4 cm, moderate; and >4 cm, severe.

Cystocele, urethrocele, rectal descent, and prolapse of the vagina, cervix, and uterine body were graded. Separate grading systems were used to evaluate for urethral hypermobility and rectocele.

Results of the Study

There were 59 women with suspected pelvic floor dysfunction. After analyzing the true FISP and HASTE images, approximately 66% of these patients had at least 1 grade more severe of prolapse on the true FISP sequence.

Pelvic organ prolapse was evident on the true FISP sequence alone in approximately 29% of patients.

However, approximately 20% of patients had a greater degree of prolapse found on the HASTE images.

Pelvic organ prolapse was evident on the HASTE sequence alone in approximately 20% of the patients.

Cystoceles and urethral mobility had a statistically significant higher grade on the FISP images.

Conclusions
Greater degrees of organ prolapse in all 3 compartments were found with a dynamic true FISP sequence compared with a sequential HASTE sequence.

Reviewer’s Comments
The results of this study provide insight to some differences between HASTE and true FISP sequences when used to evaluate for pelvic organ prolapse.

This allows for protocol flexibility, although implementation of the true FISP sequence would probably yield a higher sensitivity and grading of these disorders of the pelvic floor, as shown in this study.

Therefore, one may consider transitioning from the time-honored HASTE sequence to the true FISP sequence for this clinical indication.

A limitation noted in this study was that the readers could not be blinded regarding which sequence of images they were reviewing, and this consequently might have introduced a degree of bias.

Author: John C. Sabatino, MD

Reference:
Hecht EM, Lee VS, et al. MRI of Pelvic Floor Dysfunction: Dynamic True Fast Imaging With Steady State Precession Versus HASTE. AJR; 2008; 191 (August): 352-358

New July 2009: Diagnostic Imaging Review: For Residents, Fellows and Radiologists

The Diagnostic Imaging Review CME program highlights the fundamentals of each radiology subspecialty by incorporating recent technical and clinical advances pertinent to current practice. In addition to formal didactic lectures on practical techniques and organ systems, this program features multiple case sessions covering each of the diagnostic specialties. Click here to read more or order:

Diagnostic Imaging Review

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