Introduction: The true etiology of pelvic organ prolapse and urinary incontinence and
variations observed among individuals are not entirely understood. Tactile
(stress) and ultrasound (anatomy, strain) image fusion may furnish new insights
into the female pelvic floor conditions. This study aimed to explore imaging
performance and clinical value of vaginal tactile and ultrasound image fusion
for characterization of the female pelvic floor. Methods: A novel probe
with 96 tactile and 192 ultrasound transducers was designed. Women scheduled
for a urogynecological visit were considered eligible for enrollment to
observational study. Intravaginal tactile and ultrasound images were acquired
for vaginal wall deformations at probe insertion, elevation, rotation, Valsalva
maneuver, voluntary contractions, involuntary relaxation, and reflex pelvic
muscle contractions. Biomechanical mapping has included tactile/ultrasound
imaging and functional imaging. Results: Twenty women were successfully
studied with the probe. Tactile and ultrasound images for tissues deformation
as well as functional images were recorded. Tactile (stress) and ultrasound
(strain) images allowed creation of stress-strain maps for the tissues of
interest in absolute scale. Functional images allowed identification of active
pelvic structures and their biomechanical characterization (anatomical
measurements, contractive mobility and strength). Fusion of the modalities has
allowed recognition and characterization of levator ani muscles (pubococcygeal,
puborectal, iliococcygeal), perineum, urethral and anorectal complexes critical
in prolapse and/or incontinence development. Conclusions: Vaginal
tactile and ultrasound image fusion provides unique data for biomechanical
characterization of the female pelvic floor. Bringing novel biomechanical
characterization for critical soft tissues/structures may provide extended
scientific knowledge and improve clinical practice.
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