Khan M, Elfeky M, Weerakkody Y, et al. Pubococcygeal line. Reference article, Radiopaedia.org (Accessed on 19 Apr 2024) https://doi.org/10.53347/rID-76416
The pubococcygeal line (PCL) is a reference line for the pelvic floor on imaging studies and helps detect and grade pelvic floor prolapse in defecography studies. It is defined as a line that connects the inferior border of the symphysis pubis (anterior margin) to the final coccygeal joint (posterior margin) on a midline sagittal image.
On the image subjectively assessed as showing the greatest degree of pelvic organ descent, perpendicular lines are drawn from the PCL to the bladder neck, anterior cervical lip or vaginal apex if there has been a hysterectomy, and anterior aspect of the anorectal junction, to assess the degree of descent of the anterior, middle and posterior pelvic compartments respectively.
From the anterior and middle compartments, 1 cm is subtracted from the measured distance between the PCL and the organ-specific reference points, to allow for normal downward movement of the organs during straining 5. From the posterior compartment measurement, 3 cm is subtracted from the measured distance between the PCL and the anorectal junction. The resulting measurements are categorized as showing mild, moderate or severe descent according to the rule of 3s:
2. Harpreet K. Pannu, Howard S. Kaufman, Geoffrey W. Cundiff, René Genadry, David A. Bluemke, Elliot K. Fishman. Dynamic MR Imaging of Pelvic Organ Prolapse: Spectrum of Abnormalities1. (2000) RadioGraphics. 20 (6): 1567-82. doi:10.1148/radiographics.20.6.g00nv311567 - Pubmed
3. Lousine Boyadzhyan, Steven S. Raman, Shlomo Raz. Role of Static and Dynamic MR Imaging in Surgical Pelvic Floor Dysfunction1. (2008) RadioGraphics. 28 (4): 949-67. doi:10.1148/rg.284075139 - Pubmed
4. Laura García del Salto, Jaime de Miguel Criado, Luis Felipe Aguilera del Hoyo, Leticia Gutiérrez Velasco, Patricia Fraga Rivas, Marcos Manzano Paradela, María Isabel Díez Pérez de las Vacas, Ana Gloria Marco Sanz, Eduardo Fraile Moreno. MR Imaging–based Assessment of the Female Pelvic Floor. (2014) RadioGraphics. 34 (5): 1417-39. doi:10.1148/rg.345140137 - Pubmed
5. Rania Farouk El Sayed, Celine D. Alt, Francesca Maccioni, Matthias Meissnitzer, Gabriele Masselli, Lucia Manganaro, Valeria Vinci, Dominik Weishaupt. Magnetic resonance imaging of pelvic floor dysfunction - joint recommendations of the ESUR and ESGAR Pelvic Floor Working Group. (2017) European Radiology. 27 (5): 2067. doi:10.1007/s00330-016-4471-7 - Pubmed
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