2D perineal compared to 3D endovaginal ultrasound for evaluation of the levator ani muscles in women.

Authors

Anna Trikhacheva, Emilia Alcoba, Zinat Karimi, Laura E Berg, Qi Wei, S Abbas Shobeiri

Published in

Journal of ultrasound. Oct 28, 2026. Epub Oct 28, 2026.

Abstract

Pelvic floor therapists are incorporating mid-sagittal two-dimensional (2D) perineal pelvic floor ultrasound (pPFUS) to augment their pelvic floor digital examination. Although the mid-sagittal plane gives crucial information about pelvic floor function, it does not allow the operator to directly ascertain the integrity and thickness of the levator ani muscle (LAM). We aimed to evaluate the correlation between LAM thickness obtained with 2D pPFUS in the coronal plane and three-dimensional (3D) endovaginal ultrasound (EVUS) in the axial plane in women without pelvic organ prolapse (POP) at or beyond the hymen to evaluate if 2D pPFUS is an effective tool for visualization of LAM.
In a retrospective descriptive analysis, 2D pPFUS and 3D (EVUS) were compared to attempt visualization and quantitatively measure the puborectalis (PR), pubococcygeus (PC), and iliococcygeus (IC) within the same patient cohort. LAM thickness was recorded at mid-urethra, mid-vagina, and mid-anorectum coronal levels. Statistical analyses included comparing measurements and calculating predictive values and correlation between 2D pPFUS and 3D EVUS.
Coronal 2D pPFUS could not be used to discretely visualize the PC and IC in any patient. Comparison of PR thickness between 2 and 3D ultrasound at different levels showed positive predictive values ranging from 0.70 to 0.86, while negative predictive values ranged from 0 to 1.00 across all three levels. Moderate to high correlations were observed between measurements taken at the mid-urethra and mid-vagina using both ultrasound modalities. At the mid-anorectum level, correlation was weak and inconsistent between sides, with only a low positive correlation on the right and no significant correlation on the left.
Measurements of the LAM at the level of the PR obtained with 2D pPFUS show good correlation with those obtained using 3D EVUS at the mid-urethra and mid-vagina levels. However, 2D pPFUS is limited by its inability to visualize PC and IC muscles.

PMID:
42955667
Bibliographic data and abstract were imported from PubMed on 30 Oct 2026.

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