Alignment of the Cervix with the Vagina in Uterine Retroversion: A Possible Risk Factor in Uterine Prolapse.

Multiple observational studies have found an association of uterine prolapse with uterine retroversion. Mechanisms proposed to explain this apparent association assume that the cervix of a retroverted uterus will usually insert at the apex of the vagina, with resultant alignment of the cervix with the vagina. The angle of the axis of the cervix with the axis of the vagina was measured by two readers on 323 sagittal pelvic MRI scans and sagittal reconstructions of pelvic CT scans performed for clinical purposes. One reader observed and recorded the anatomic relations of the uterus that differed by insertion site and version: 44 of 49 retroverted uteri (89.8%) inserted at the vaginal apex, and 13 of 274 anteverted uteri (4.7%) inserted at the vaginal apex. This difference was found to be statistically significant (p < 0.05) by the Chi square test. The urinary bladder, vaginal walls, and rectum were inferiorly related to anteriorly inserted anteverted uteri. Only the vaginal lumen and the rectum at a shallow oblique angle were inferiorly related to apically inserted retroverted uteri. Most retroverted uteri insert at the apex of the vagina. Apically inserted retroverted uteri appear to receive less support from adjacent structures than anteriorly inserted anteverted uteri.

Vaginal Anatomy on MRI: New Information Obtained Using Distention.

OBJECTIVES: To demonstrate and confirm the presence of three anatomic zones of the vagina (a superficial sphincteric zone; a central wedge shaped transition zone; and a deep, expanded forniceal zone) using pelvic magnetic resonance imaging with contrast distention of the vagina. METHODS: A total of 107 consecutive female pelvic magnetic resonance imaging scans using vaginal contrast distention were retrospectively reviewed. The images were observed for the three-zone configuration. Anteroposterior and transverse diameter measurements were taken in the proximal, mid, and distal sphincteric, transition, and forniceal zones. Means and standard deviations were calculated at each site. Adjacent sites were compared using paired t tests. RESULTS: The three-zone configuration was observed in all of the cases but one. Statistically significant increases and decreases of mean anteroposterior diameters occurred at all levels expected by visual observation. CONCLUSIONS: The three-zone configuration of the distended vagina was confirmed by this study. The configuration of the vagina is more complex than has been reported previously. This configuration may facilitate parturition and may be useful in the design of intravaginal devices.

Effectiveness and safety of image-directed biopsies: coaxial technique versus conventional fine-needle aspiration.

BACKGROUND: We compared the effectiveness and safety of image-guided biopsies done with coaxial guides versus fine-needle aspiration done without coaxial guides. METHODS: With the use of hospital computer records and chart reviews, all image-guided biopsies done during a 4-year period at our institution were assessed for adequacy and complications. For each biopsy, the use of a coaxial guide, the site, and the imaging modality were recorded. Adequacy of the biopsy and complications were compiled. Success rates were calculated for conventional and coaxial biopsies and by modality and site. RESULTS: Coaxial technique reduced the number of unsatisfactory biopsies compared with conventional technique in extrathoracic sites. The decrease was statistically significant. No major complications occurred from extrathoracic biopsies with either technique. No difference was found in success rates or complication rates between ultrasound-guided and CT-guided biopsies using coaxial technique. CONCLUSION: Coaxial technique reduces the number of inadequate biopsies in extrathoracic sites, without a detectable increase in complications.