A Magnetic Resonance Imaging (MRI)

Measure of Intramuscular Fat in Pelvic Floor

Musculature of Nulliparous Women
Laura La Porta Krum PT, PhD, OCS
Angie Mueller SPT
Eric Utes SPT
Meghan Adams-Jorg SPT
Katie Anderson SPT
Kristin Johnson SPT
Layna Shorter SPT
James Elliott PT, PhD
 Role of the Pelvic Floor

• Supports the pelvic organs

• Contributes to urinary and fecal continence
• Assists in lumbopelvic stability
• Contributes to sexual arousal and performance

Background Purpose Methods Results Conclusion

 Pathologies of Pelvic Floor
Dysfunction
• 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. Obstet Gynecol. 2006)
– Reported by 25-75% women postpartum (Gregory, & Nygaard. Clininal Obstet 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)

Background Purpose Methods Results Conclusion

 Research Question

Can a novel MR imaging technique

be developed that is sensitive enough to
identify markers of pelvic floor
damage?
 Key Studies: Elliott et al. (2006)
• Quantification of intramuscular fat using
signal intensity from T1 weighted MRI images
– Muscle/Fat Index
Elliot J et al. Spine. 2006;22:E847-E855

Background Purpose Methods Results Conclusion

 MRI Measure

Pixel Intensity Profile

www.mricro.com
Rorden, 2000
 Key Studies: Margulies et al. (2006)
• 80 nulliparous women with normal pelvic support

• Described 5 levator ani subdivisions using T2 weighted axial,

coronal, and sagittal MRI scan planes
– Pubovisceral (puboanal, puboperineal, pubovaginal)
– Puborectal
– Illiococcygeal

• Pubovisceral (PV) selected as muscle region of interest

Background Purpose Methods Results Conclusion

Key Studies

Margulies R et al. Obstet Gynecol. 2006;107:1064–9

 UsePilot
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and
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studies
muscle/fat
investigating
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.

Background Purpose Methods Results Conclusion

 Participants
• 20-40 yr old females (N=8)
• Inclusion Criteria
– Caucasian, nulliparous
• Exclusion Criteria
– Hx of PFD

Background Purpose Methods Results Conclusion

 Procedures
• Informed consent
• Outcome Measures
– QUID, IIQ-7, I-QOL,
RADL, PDI
• Weight
• Height
• Body fat
• Manometry
• MRI

Background Purpose Methods Results Conclusion

 MRI Measures
• PV and Obteratur Internus (OI) measured at
the level of the proximal and middle urethra
Proximal Urethra

Background Purpose Methods Results Conclusion

 Middle Urethra

Background Purpose Methods Results Conclusion

 Region of Interest

Background Purpose Methods Results Conclusion

 Data Analysis
Region of Interest (ROI) converted
into scaled intensity profile
(min/mean/max) per muscle

Background Purpose Methods Results Conclusion

 Reliability
Level Selection Muscle ROI
• ICC (2,1) = 1.0 • ICC (2,1) = 1.0
(Interrater) (Interrater)

• ICC (3,1) = .92 • ICC (3,1) = 1.0

(Intrarater) (Intrarater)

Background Purpose Methods Results Conclusion

Mean muscle SI
Mean fat SI ~ .1111%
+ .02
 Clear to Proceed!
• Establish normative data

• Use to identify pelvic floor muscle change due

to pregnancy (post cesarean) and post-vaginal
delivery

Background Purpose Methods Results Conclusion

 Future Research
• Relationship of signal intensity changes of
pelvic floor muscles
– Pain
– Pelvic floor dysfunction
– Quality of life measures in symptomatic and/or
postpartum women

• Develop diagnostic markers for early

detection and/or treatment

Background Purpose Methods Results Conclusion

 Research Support
• Regis University SPARC Award
• The University of Queensland, Australia- Post-
Doctoral Research Funds

THE UNIVERSITY
OF QUEENSLAND
AUSTRALIA