Ultrasound in Obstetrics & Gynecology vol:30 issue:4 pages:448-448
World Congress on Ultrasound in Obstetrics and Gynecology edition:17 location:Florence, Italy date:7 - 11 October 2007
Objectives: Investigation of the level of agreement between 3D/4D transperineal ultrasound (TUS) and colpocystodefecography (CCD)in the evaluation of posterior compartment prolapse (PCP).
Methods: Some 114 women were recruited retrospectively. CCD
was performed, using a standardized technique. TUS was performed in the supine position, after voiding, using a GE Kretz Voluson 730 Expert system and a RAB 4–8-MHz probe. Volumes were acquired at rest, Valsalva and straining. Offline analysis of the datasets was performed using 4D View GE Kretz software. PCP was defined if point Bp and or point D of the ICS POP-Q scoring system for pelvic organ prolapse was ≤ –2. Enterocele was considered clinically
relevant if there was herniation of bowel of more than halfway from the vagina into the rectovaginal septum. Rectocele was considered clinically relevant if there was a defect of the rectovaginal septum of more than 30 mm measured on CCD and more than 10 mm on ultrasound, seen as a sharp discontinuity in the ventral anorectal muscularis.
Results: Fifty-four patients were diagnosed with a PCP. Enterocele was diagnosed in 24 patients (46%) on CCD and in 30 patients (58%) on transperineal ultrasound. For enterocele the Cohen’s kappa level of agreement between CCD and ultrasound was 0.57. In 91% there was a positive agreement between the methods for the diagnosis of an enterocele, with a negative agreement in 67% of the cases. Clinically relevant rectocelewas found in 22 patients (46%) on CCD and in 22 patients on ultrasound (46%). For rectocele Cohen’s kappa was 0.44. Positive agreement between the investigations for rectocele was found in 68%, with a negative agreement in 77%.
Conclusions: A moderate level of agreement was observed between the two methods. 3D/4D transperineal ultrasound could be used as the first non-invasive diagnostic tool, followed by CCD or dynamic MRI if there is discrepancy between the clinical findings and ultrasound.