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Comparing 3-Dimensional Ultrasound to 3-Dimensional Magnetic Resonance Imaging in the Detection of Levator Ani Defects

Calderwood, Camille S., MD*; Thurmond, Amy, MD; Holland, Amanda, MPH*; Osmundsen, Blake, MD; Gregory, W. Thomas, MD*

Female Pelvic Medicine & Reconstructive Surgery: July/August 2018 - Volume 24 - Issue 4 - p 295–300
doi: 10.1097/SPV.0000000000000485
Original Articles

Objective The aim of this study was to compare the detection of levator ani defects (LAD) between 3-dimensional (3D) ultrasound (US) and 3D magnetic resonance imaging (MRI).

Methods This is a secondary analysis of the Pelvic Floor Nerve Injury Following Childbirth Study. Nulliparous women underwent a standardized protocol of pelvic floor evaluations between January 2008 and December 2013, prior to pregnancy (V1) and at 2 points postpartum: 6 weeks (V2) and 6 months (V3). Those women who underwent a high-resolution 3D MRI pelvic floor sequence were selected. Comparisons were made to concomitantly acquired 3D perineal US. Eight tomographic slices were examined in the axial plane, each side independently scored with 0 (no defect) or 1 (defect). A similar tomographic approach was applied to the MRI. For both MRI and US, the right and left sides were each scored. A total score of 0 to 8 was given to each side. A dichotomous variable “complete LAD” was defined. Cohen κ was used as a measurement of agreement of complete LAD between MRI and US. Kendall τ b was used to correlate total scores.

Results On the right side, 80 (90%) of 89 pairs were in agreement (concordant in the diagnosis or not of a “defect”). On the left side, 72 (81%) of 89 pairs were in agreement. Correlations (Cohen κ) of complete LAD were 0.65 (P < 0.001) on the right and 0.37 (P < 0.001) on the left. Correlations of total scores were 0.47 (P < 0.001) on the right and 0.41 (P < 0.001) on the left.

Conclusions Moderate agreement was found between 3D US and 3D MRI LAD detection. More LADs and discordance were seen on the left.

A comparison of 3-dimensional magnetic resonance imaging and 3-dimensional ultrasound for the detection of levator ani defects finds a moderate correlation between the findings of these 2 imaging techniques.

From the *Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland;

Women's Imaging & Intervention, Lake Oswego; and

Legacy Good Samaritan Medical Center, Portland, OR.

Correspondence: Camille S. Calderwood, MD, Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics & Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Mail Code L466, Portland, OR 97239. E-mail:

Funding was provided by the National Institute of Child Health & Human Development (grant R01 HD049541).

The authors have declared they have no conflicts of interest.

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