with urinary incontinence or organ prolapse (Gufler et al. 1999b). Cystourethrography alone missed all rectoceles, which were correctly depicted by colpocystorectography and MRI, whereas enteroceles could only be diagnosed by MRI. Comparing colpocystorectography in the upright and supine position with functional MRI no significant difference between MRI and colpocystorectography in either positions was found (Gufler et al. 1999b). Kelvin et al. compared cystocolpoproctography with opacification of all relevant organs to functional MRI in the supine position with opacification of the bladder, vagina, and rectum and added also a post-toilet phase (Kelvin et al. 2000). They conclude that MR imaging and cystocolpoproctography showed similar detection rates for prolapse of pelvic organs but emphasized the strength of MRI as revealing all pelvic organs and pelvic floor musculature. In the ACR recommendations, if available upright MRI is favored over supine position (Pannu et al. 2015). Some studies using a midfield system of 0.5 T with an open magnet configuration are published (Kim 2011; Lone et al. 2016; Lienemann et al. 1997; Sprenger et al. 2000). The latter offers the advantage of evaluating the patient in an upright position, but were limited by a reduced imaging quality due to the surface coil design and limited spatial and temporal resolution. Bertschinger et al. showed that MRI in sitting position was not superior to supine MRI in depiction of clinically relevant bladder prolapse or rectoceles (Bertschinger et al. 2002). Similarly Fielding et al. reported a higher degree of pelvic floor laxity for sitting position that was not superior to supine MRI (Fielding et al. 1998). A recent study compared MRI in supine versus sitting position using a 0.25 T open configuration and 1.5 T MRI unit in 31 (27 females) patients (van Iersel et al. 2017). At rest and defecation no significant difference of the anorectal junction and no significant difference in percentages of cystoceles were found. However, a statistical difference was documented in comparing the grade of descent. These authors conclude that MRI may overestimate the descent due to the more cranial position of the pelvic organs in supine position at rest (van Iersel et al. 2017).

The data on MRI to assess intususceptions are conflicting. Compared with conventional techniques MRI tends to underestimate intussusception which may be due to nonphysiological supine position, but global information of the pelvic floor can be rendered (Pannu et al. 2015; van Iersel et al. 2017). A recent study assessing 41 patients reported superiority of conventional defecography for diagnosing rectoceles and enteroceles, but found MRI more effective for identifying intussusceptions (van Iersel et al. 2017). Advantages of MRI in assessing rectal intussusception include differentiation of mucosal from full-thickness involvement, functional information of pelvic floor movement, and depiction of coexisting pathologies (Mortele 2007). Similarly in suspected dyssynergetic pelvic floor syndrome the value of MRI is rendering comprehensive information. It visualizes the typical features of abnormal defecation and also aids in elucidating other causes of pelvic outlet obstruction (Reiner et al. 2011; Mortele 2007; Bolog and Weishaupt 2005).

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