Diffusion tensor imaging and fiber tractography for the visualization of the female pelvic floor

In the past decade, the evaluation of the pelvic support for understanding pelvic floor dysfunction by means of magnetic resonance imaging (MRI) has been an emerging area of research. Both static and dynamic MRI techniques have been effectively applied as a diagnostic resource to reveal abnormalities to the muscular pelvic support, but fail to unravel the precise pathophysiology of this complex disorder. Diffusion tensor imaging (DTI) and tractography comprise enhanced MRI techniques that enable the three-dimensional visualization of anisotropic tissue, such as muscle fibers, and provide a quantitative description of tissue organization and integrity. Quantifying DTI and fiber tractography might be able to reveal microstructural abnormalities in the pelvic support that are not noticeable using conventional MRI techniques. In this article, we discuss relevant anatomy, the current state of DTI and tractography in the evaluation of the female pelvic floor, and their potential future clinical applications. Clin. Anat. 26:110114, 2013. (c) 2012 Wiley Periodicals, Inc.