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MR Imaging of the Female Urethra and Supporting Ligaments in Assessment of Urinary Incontinence: Spectrum of Abnormalities¹

¹ From the Russell H. Morgan Department of Radiology and Radiological Science (K.J.M., D.A.B.) and Department of Obstetrics and Gynecology (R.R.G.), Johns Hopkins Medical Institutions, 600 N Wolfe St, BLA-B 179 RAD, Baltimore, MD 21287. Presented as an education exhibit at the 2004 RSNA Annual Meeting. Received June 17, 2005; revision requested July 15 and received September 7; accepted September 7. K.J.M. supported by an RSNA Research Seed Grant and the Young Investigator Award from the Society of Computed Body Tomography and Magnetic Resonance. The authors discuss an investigational or unlabeled use of a commercial product, device, or pharmaceutical that has not been approved for such purpose by the FDA. D.A.B. receives research support from Surgi-Vision, Columbia, Md; all other authors have no financial relationships to disclose. Address correspondence to K.J.M. (e-mail: kmacura{at}jhmi.edu).

The traditional methods for evaluation of urinary incontinence in women include urodynamics, cystourethroscopy, cystourethrography, and ultrasonography. Magnetic resonance (MR) imaging has not played a major role in the assessment of women with urinary incontinence. However, high-resolution MR imaging allows detailed visualization of the urethral sphincter and supporting ligaments in women and may contribute to the diagnosis and staging of sphincteric incompetence related to intrinsic sphincter deficiency or urethral hypermobility. Both the anatomy and the function of the female urethra can be depicted on MR images. The spectrum of abnormalities detected at MR imaging in women with stress urinary incontinence are classified as (a) findings related to the urethral sphincter deficiency and (b) defects of the urethral support ligaments and urethral hypermobility. These abnormalities include a small urethral sphincter, funneling at the bladder neck, distortion of the urethral support ligaments, cystocele, an asymmetric pubococcygeus muscle, abnormal shape of the vagina, enlargement of the retropubic space, and an increased vesicourethral angle.

© RSNA, 2006

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