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Am Fam Physician. 2004;70(3):586

Physicians rely on digital examination to diagnose and assess prolapse of the vaginal vault. Advances in three-dimensional magnetic resonance imaging (3D-MRI) may provide detailed information about displacement of pelvic organs, but the applications of 3D-MRI to clinical practice are unclear. Cortes and colleagues compared digital examination with 3D-MRI in the diagnosis of vaginal vault prolapse.

They studied 51 women who were 40 to 95 years of age (mean age, 64 years) who were referred to a London teaching hospital for assessment of symptoms suggesting vaginal vault prolapse after hysterectomy. Three experienced gynecologists examined all participants in standing and dorsal supine positions and recorded results using a standardized grading system. The women were then examined by 3D-MRI in resting and straining situations. If significant divergence was noted between the MRI and the clinical assessment, the patient was re-examined clinically during corrective surgery.

Correlation between MRI and clinical assessment was poor. In the anterior and posterior compartments, the two assessments agreed in only one third of cases. In the middle compartment, the two assessments agreed in 41 percent of cases. In the anterior and posterior compartments, clinical examination overdiagnosed 19 cases (37 percent) and underdiagnosed 15 cases (29 percent) compared with MRI findings. In the middle compartment, 27 cases (53 percent) were overdiagnosed and only three (6 percent) were underdiagnosed clinically compared with MRI.

The authors conclude that clinical assessment of prolapse correlates poorly with MRI findings, especially in vaginal apex prolapse. Some of this difference may reflect the positioning of patients during examination. Nevertheless, dynamic MRI may provide a useful complementary assessment in women with vaginal prolapse.

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