Variations in Female Pelvic Anatomy via MRI: A Retrospective Study at Single Academic Institution

Background/Objectives: Pelvic floor disorders affect up to 30% of adult females in the United States. Misdiagnosis occurs in nearly 45% to 90% of cases. Standardized pelvic anatomical measurements could improve diagnostic accuracy and treatment planning. We aimed to evaluate pelvic anatomical variations using magnetic resonance imaging (MRI). Methods: We analyzed MRI pelvic measurements from 250 women aged 20–90 years. Exclusion criteria included prior pelvic surgery (except hysterectomy), pelvic cancer, and use of alternative imaging modalities. Key measurements included anterior vaginal wall thickness (AVWT), bladder wall thickness (BWT), vaginal epithelium to bladder urothelium (VWBU), urethral length (UL), and inter-ureteral distances. A comprehensive statistical analysis was performed, including corrections for multiple comparisons. Results: While several anatomical measurements were correlated, a comprehensive analysis was performed to identify markers for clinical diagnoses. After applying Bonferroni correction for multiple comparisons, we found no statistically significant association between any of the measured anatomical parameters and a diagnosis of incontinence. Notably, an uncorrected difference in Bladder Wall Thickness (BWT) (p = 0.041) did not hold up to rigorous testing. To further assess its clinical utility, a Receiver Operating Characteristic (ROC) curve analysis for BWT as a predictor of incontinence yielded an aArea Under the Curve (AUC) of 0.19, indicating poor predictive validity. Conclusions: In this cohort, static anatomical measurements derived from MRI, including BWT, do not appear to be reliable markers for incontinence. Our findings suggest that the pathophysiology of this disorder is likely more dependent on functional or dynamic factors rather than simple static anatomical variations. Future research should focus on standardizing dynamic imaging parameters to better assess pelvic floor function.