Novel MRI Method Enhances Evaluation of Pelvic Organ Prolapse, Suggests Research

The findings, published in the American Journal of Obstetrics and Gynecology, suggest its potential to enhance diagnostic accuracy, optimize treatment planning, and improve patient outcomes.

Pelvic magnetic resonance imaging (MRI) is used widely to assess the severity of pelvic organ prolapse. Traditionally, the pubococcygeal line serves as a standard reference for such evaluations, focusing on the lowest points in the anterior, middle, and posterior compartments of the pelvis. However, this method overlooks the involvement of other pelvic floor structures and their interactions, which are essential for a comprehensive understanding of the prolapse.

To address this gap, Chenxin Zhang, Institute of Medical Technology, Peking University Health Science Center, Beijing, China, and colleagues introduced and tested a new measurement method called the area under the pubococcygeal line. This approach aims to offer a more holistic assessment of pelvic organ prolapse. The study evaluated how well this method aligns with clinical Pelvic Organ Prolapse Quantification staging and tested its consistency across different raters to confirm its reliability.

For this purpose, the researchers enrolled 225 women who underwent MRI evaluations and clinical POP-Q staging. They used statistical methods—including descriptive analysis, correlation analysis, reliability testing, and ordinal logistic regression—to assess how well the area under the pubococcygeal line measurement works and how consistently it can be applied across different cases.

The study revealed the following findings:

• Increased values of the area under the pubococcygeal line were significantly associated with higher Pelvic Organ Prolapse Quantification stages.
• The area under the pubococcygeal line showed a strong positive correlation with POP-Q stages (Spearman’s r = 0.878).
• This correlation was stronger than traditional pubococcygeal line grades (Spearman’s r = 0.777).
• Reliability testing showed excellent consistency, with intraclass correlation coefficients of 0.980 (intrarater) and 0.906 (interrater).
• Ordinal logistic regression confirmed a significant association between the area under the pubococcygeal line and POP-Q severity levels.

The findings showed that the area under the pubococcygeal line measurement represents a novel and comprehensive MRI-based technique for evaluating pelvic organ prolapse.

The authors noted that the AUPCL method, by capturing key pelvic floor structures, exhibits a strong correlation with clinical POP-Q stages and demonstrates excellent intra- and interrater reliability. They added that this technique holds significant potential to improve diagnostic accuracy, guide treatment planning, and enhance patient outcomes.

“While further validation is needed, AUPCL could serve as a valuable complement to existing imaging methods in the evaluation and management of pelvic organ prolapse,” they concluded.

Reference:

Zhang, C., Li, X., Xie, B., Gao, L., Feng, Y., Sun, X., Luo, J., & Wang, J. (2025). A novel pelvic magnetic resonance imaging measurement for pelvic organ prolapse evaluation. American Journal of Obstetrics and Gynecology, 232(4), 383.e1-383.e8. https://doi.org/10.1016/j.ajog.2024.10.007