Agreement and reliability of pelvic floor measurements during rest and on maximum Valsalva maneuver using three‐dimensional translabial ultrasound and virtual reality imaging

• Published in: Ultrasound in obstetrics & gynecology Vol. 48; no. 2; pp. 243 - 249
• Main Authors: Speksnijder, L., Oom, D. M. J., Koning, A. H. J., Biesmeijer, C. S., Steegers, E. A. P., Steensma, A. B.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.08.2016; Wiley Subscription Services, Inc
• Subjects: 3D translabial ultrasound; Adult; Aged; agreement; Agreements; Algorithms; Computer Simulation; Female; Humans; Imaging, Three-Dimensional - methods; levator hiatus; Middle Aged; Observer Variation; pelvic floor muscles; pelvic organ prolapse; Pelvic Organ Prolapse - diagnostic imaging; Perineum - diagnostic imaging; reliability; Reproducibility of Results; Rest; Ultrasonic imaging; Ultrasonography; Valsalva Maneuver; Virtual reality; virtual reality imaging; Young Adult; 3D translabial ultrasound; agreement; levator hiatus; reliability; pelvic floor muscles; virtual reality imaging; pelvic organ prolapse
• ISSN: 0960-7692; 1469-0705
• DOI: 10.1002/uog.15785

ABSTRACT Objectives Imaging of the levator ani hiatus provides valuable information for the diagnosis and follow‐up of patients with pelvic organ prolapse (POP). This study compared measurements of levator ani hiatal volume during rest and on maximum Valsalva, obtained using conventional three‐dimensional (3D) translabial ultrasound and virtual reality imaging. Our objectives were to establish their agreement and reliability, and their relationship with prolapse symptoms and POP quantification (POP‐Q) stage. Methods One hundred women with an intact levator ani were selected from our tertiary clinic database. Information on clinical symptoms were obtained using standardized questionnaires. Ultrasound datasets were analyzed using a rendered volume with a slice thickness of 1.5 cm, at the level of minimal hiatal dimensions, during rest and on maximum Valsalva. The levator area (in cm2) was measured and multiplied by 1.5 to obtain the levator ani hiatal volume (in cm3) on conventional 3D ultrasound. Levator ani hiatal volume (in cm3) was measured semi‐automatically by virtual reality imaging using a segmentation algorithm. Twenty patients were chosen randomly to analyze intra‐ and interobserver agreement. Results The mean difference between levator hiatal volume measurements on 3D ultrasound and by virtual reality was 1.52 cm3 (95% CI, 1.00–2.04 cm3) at rest and 1.16 cm3 (95% CI, 0.56–1.76 cm3) during maximum Valsalva (P < 0.001). Both intra‐ and interobserver intraclass correlation coefficients were ≥ 0.96 for conventional 3D ultrasound and > 0.99 for virtual reality. Patients with prolapse symptoms or POP‐Q Stage ≥ 2 had significantly larger hiatal measurements than those without symptoms or POP‐Q Stage < 2. Conclusions Levator ani hiatal volume at rest and on maximum Valsalva is significantly smaller when using virtual reality compared with conventional 3D ultrasound; however, this difference does not seem clinically important. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.