Fig. 9
From: Dynamic magnetic resonance imaging of the female pelvic floor—a pictorial review
Importance of the evacuation phase. (a, b, c) Sagittal midline TrueFISP images at rest (a), during straining (b), and evacuation (c) of a patient with descending perineal syndrome with tricompartimental prolapse, anterior rectocele, and rectal mucosa intussusception. Note that, although in the straining phase (b) the H and M lines (blue and right green lines) are already above the normal values, indicating a descending perineal syndrome, and a mild bulge of the anterior rectal wall is seen (white arrow), only in the evacuation phase (c) the true pelvic floor disorder is adequately characterized, with a tricompartimental prolapse (cystocele, uterine prolapse, and rectal prolapse) the true size of the rectocele is documented (orange line: 4.8 cm) and the rectal mucosa intussusception is depicted (red arrow). Left green line: extent of cystocele; purple line: extent of uterine prolapse; black line: normal expected contour of the anterior anorectal wall; red line: PCL line