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Session: Soft Tissue & Abdominal Organs
Session starts: Thursday 24 January, 13:30
Presentation starts: 13:30
Room: Lecture room 559

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Shreya Das (Radboudumc)
Hendrik H.G. Hansen (Radboudumc)
Frieda van den Noort (University of Twente)
C. Huub van der Vaart (UMC Utrecht)
Chris L. de Korte (Radboudumc, University of Twente)

Abstract:
ABSTRACT Female pelvic floor muscles provide support by compensating for gravity and abdominal pressure. During delivery some of them have to stretch up to three times their original length to allow for the passage of the baby. Frequently these muscles (for example, the puborectalis muscle or PRM) get damaged during childbirth, which can lead to irreversible damage. Due to this damage, women may suffer from disorders like pelvic organ prolapse or urinary and fecal incontinence [1-2]. 3D ultrasound (US) imaging can be used to image these muscles and detect the most severe cases of muscle damage. However, diagnosis of the damage is currently done in static images obtained from the US movies, which is observer dependent and not reproducible [3]. Our hypothesis is that by US-based strain imaging the exact deformation and motion of these muscles can be quantified which will aid in diagnosing muscle failure and allow a patient specific treatment strategy. Transperineal 3D ultrasound movies were obtained from female volunteers (n=9) at 12 weeks of their first pregnancy, using a curved array volume transducer connected to a GE Voluson V730 US machine at the University Medical Centre, Utrecht, The Netherlands. Volumetric DICOM US data were acquired of the PRM starting at rest and via, contraction and relaxation by Valsalva maneuver, back to rest again. Displacements were estimated in 3D using a normalized coarse-to-fine cross-correlation-based algorithm [4]. All displacements were calculated with respect to a reference frame chosen in rest just before contraction. Displacements were calculated for a manually segmented region of interest (ROI) corresponding to the PRM [5]. Finally, axial strains were calculated using a 3D Least Squares Strain Estimator (LSQSE) [4, 6]. Preliminary results, show that axial strains of the PRM produces negative and positive strain values at contraction and Valsalva, respectively. Future studies in multiple volunteers will have to explore the reproducibility of our method and investigate if strain imaging can be used to quantify damage of the PRM. Furthermore, it is also being investigated if strain accuracy can be improved by incorporating tracking, implying the reference frame and ROI for displacement calculation is being updated frame by frame during the performance of the rest-contraction-Valsalva-rest procedure and strain is accumulated afterwards. References: [1] Bedretdinova D., et al.; Eur Urol 69(2):256-64, 2016. [2] Dieter AA, et al.; Curr Opin Obstet Gynecol 27(5):380-4, 2015. [3] van Veelen GA., et al.; Int Urogynecol J 25(11):1501-6, 2014. [4] Hendriks, GAGM, et al.; Phys Med Biol 61(7):2665-79, 2016. [5] van den Noort, F, et al.; Ultrasound Obstet Gynecol, epub ahead of print, 2017. [6] Kallel F, et al.; Ultrason Imaging 19(3):195-208, 1997.