From the Guidelines
For evaluating a sacral colpopexy issue, MRI is the best imaging modality. This is because MRI allows for anatomic evaluation of the pelvic organs and structural changes after surgery, including the assessment of sacrocolpopexy mesh and associated complications such as presacral hematomas, bowel or bladder injury, peritoneal inclusion cyst formation, mesh infection, or discitis/osteomyelitis at the sacral promontory 1. The inherent high soft-tissue contrast resolution of MRI enables detailed visualization of the pelvic floor anatomy, mesh placement, and potential complications.
When performing an MRI for sacral colpopexy evaluation, it is recommended to use a pelvic protocol with gadolinium IV contrast to better depict complications such as collections or fistula 1. The examination should be performed to assess the integrity of the sacrocolpopexy mesh and associated complications.
Key benefits of using MRI for this purpose include:
- Better soft tissue resolution compared to CT scans
- No radiation exposure
- Ability to assess the functional aspects of the repair
- Detailed visualization of mesh placement and potential complications
- Ability to evaluate the integrity of sacrocolpopexy mesh and associated complications
Other imaging modalities, such as ultrasound, CT scans, and X-rays, are not preferred for evaluating sacral colpopexy issues due to their limited ability to provide comprehensive anatomical detail and soft tissue resolution 1. Defecography (either MR or conventional) may be considered as a complementary study if defecatory dysfunction is present.
From the Research
Imaging Options for Sacral Colpopexy Issues
To evaluate sacral colpopexy issues, various imaging modalities can be employed, each with its own strengths and weaknesses. The choice of imaging depends on the specific complication suspected.
- For acute complications such as bleeding or urinary tract injury, CT is generally used 2.
- For more chronic complications like mesh extrusion or exposure, with or without fistulization to surrounding structures, MRI is preferred 2.
- In cases of suspected bowel obstruction, CT is the imaging modality of choice 2.
- For suspected infection, abscess formation, and discitis or osteomyelitis, MRI may be used, although CT can also be appropriate in certain scenarios 2.
- When evaluating sacral fractures, specific radiographic measurements are crucial, including anterior-posterior sacral fracture displacement, vertical sacral fracture displacement, and degree of central canal involvement, which can be assessed using CT scans with axial, coronal, and sagittal reconstructions 3.
Considerations for Imaging Sacral Issues
It's essential to consider the type of sacral issue when selecting an imaging modality.
- For sacral tumors, radiography, CT, and MRI are primary modalities for assessing morphology and tumor extent, while PET/CT is crucial for evaluating systemic disease 4.
- The imaging approach should also take into account the potential for tumor mimics, such as developmental entities, infections, and insufficiency fractures 4.
- In the context of sacral colpopexy, understanding the normal appearance of the mesh and its potential complications is vital for accurate imaging interpretation 2.