CT成像联合盆底MRI评估压力性尿失禁患者尿道功能的价值OA

Objective:To analyze the value of computed tomography(CT)imaging combined with magnetic resonance imaging(MRI)for pelvic floor in assessing urethral function of patients with stress urinary incontinence(SUI).Methods:From June 2022 to May 2024,the clinical data of 180 female patients with SUI,who admitted to People's Hospital of Xinjiang Uygur Autonomous Region,were selected,which included 96 cases with urethral hypermobility syndrome-stress urinary incontinence(UHS-SUI),and 84 cases with intrinsic sphincter deficiency-stress urinary incontinence(ISD-SUI),and they were included into SUI group.A total of 100 healthy women who participated in physical examinations at the same hospital during the same period were selected as the control group.All subjects underwent CT combined with MRI examination on pelvic floor.The CT imaging indicators[urethral inclination angle(UIA),bladder neck descent(BND),retro vesicourethral angle(RVA)],MRI indicators[urethral sphincter thickness(UST),levator ani hiatus area(LHA),functional urethral length(FUL)]were recorded at the resting state and the Valsalva maneuver(holding breath and exerting force after deep inhalation,simulating the state of coughing or increase of abdominal pressure).Pearson correlation was used to analyze the relationships between CT imaging combined with MRI quantitative indicators on pelvic floor,and SUI.The receiver operating characteristic(ROC)curve and decision curve were used to analyze the assessment value of CT imaging and MRI quantitative indicators on pelvic floor for different types of SUI.Results:The results of CT imaging and MRI examinations on pelvic floor showed that the UIA,BND,RVA,UST and LHA of SUI group were higher than those of control group at both the resting state and Valsalva maneuver,while the FUL was lower than that of control group,and the differences of them were statistically significant(tresting=13.556,24.982,24.257,2.464,19.767,8.048,tValsalva action=31.494,31.085,22.888,5.663,30.330,14.270,P<0.05).The FUL of UHS-SUI patients was higher than that of ISD-SUI patients at resting state,and the difference was significant(t=8.930,P<0.05).However,the UIA,RVA,UST and LHA values of UHS-SUI patients were larger than these of ISD-SUI patients at Valsalva maneuver,and the differences were statistically significant(t=8.386,7.940,8.614,8.155,P<0.05).Pearson correlation analysis indicated that the UIA,BND,RVA,UST,and LHA values were all appeared positive correlations with SUI at resting state and Valsalva maneuver(rresting=0.631,0.795,0.824,0.146,0.764,rValsalva actions=0.856,0.866,0.808,0.294,0.855,P<0.05).FUL appeared negative correlation with SUI(r=-0.435,-0.650,P<0.05).The ROC curve indicated that the areas under curve(AUC)values of UIA,RVA,UST and LHA were respectively 0.810,0.799,0.812 and 0.797 in assessing ISD-SUI at Valsalva maneuver,while the AUC value of FUL was 0.821 in assessing ISD-SUI at resting state.All of these had a certain assessment value.The decision curve was drawn,and UIA,RVA,UST and LHA at the Valsalva maneuver,and FUL at the resting state had a certain assessment value for ISD-SUI.In addition,the RVA,UST and LHA could increase net benefit rate of assessing ISD-SUI when CT imaging combined with MRI measure on pelvic floor at Valsalva maneuver.Conclusion:CT imaging and MRI on pelvic floor can quantitatively assess the urethral function of female SUI patients,which can measure FUL value through CT at resting state,and measure UIA value through CT at Valsalva maneuver,and measure RVA,UST and LHA values through MRI at Valsalva maneuver.It has a certain assessment value for different SUI types.The combined assessment of CT and MRI indicators can obtain a higher benefit rate.