Health Organization for Pudendal Education

MRI of the pelvis
MRI of the pelvis was performed utilizing coronal fast inversion
recovery followed by coronal, sagittal, axial and oblique axial fast
spin echo techniques. Specific concern is pudendal nerve entrapment.
The patient reports both motor and sensory symptoms and is status post
left pudendal nerve decompression 02/19/2010, as well as treatment for
anal fistula in 2005. The patient has also undergone bilateral hernia
repair. Specific concern is entrapment in the Alcock's canal or at the
sacrotuberous ligament.
There is mild anterior deviation of the coccyx. Oblique and axial
images demonstrate that the coccyx is minimally deviated towards the
left but there is no coccygeal entrapment of the branch of the pudendal nerve to the rectum. The presacral and precoccygeal fat planes are maintained.
At the posterior margin of the pelvis, there is asymmetry of the
sacrotuberous ligaments. Moderate intermediate signal intensity scar tissue is seen to form at the posteromedial border of the left sacrotuberous ligament, seen to best advantage on series 7, images 26 through 38. Note is made of preservation of the fat planes around the right sacrotuberous ligament. This scar formation around the left ligament does focally encase a portion of the left pudendal nerve at the posterior margin of Alcock's canal. More anteroinferiorly, there is additional scarring of the pelvic floor, entrapping the anterior portion of the pudendal nerve, extending to the posterior aspect of the dorsal nerve to the penis. This is present bilaterally, right greater than left. Note is made of scarring of the pelvic floor fat at the anterior right aspect of the Alcock's canal seen on series 7, image 36. Scar formation tethers to the anteroinferior medial border of the obturator internus muscle. The distal branch nerves at the base of the penis are unremarkable.
The obturator nerves are unremarkable. The study was not centered on
the genitofemoral or ilioinguinal nerves but they appear symmetric bilaterally.
Hamstring origins are degenerated but not torn. There is no scar
entrapment of the sciatic nerves. No ischial bursitis is seen.
There is no occult fracture or osteonecrosis. No bulky synovitis is demonstrated.
There is no pelvic floor adenopathy.
Impression:
MRI of the pelvis demonstrates scar entrapment of the pudendal nerve in two locations, one localized adjacent to hypertrophic scar formation at the left sacrotuberous ligament, and also at the base of the pelvic floor and the anterior portion of Alcock's canal, entrapping the posterior margin of the dorsal nerve to the penis bilaterally, left greater than right. Findings may account for sensory symptoms relevant to the pelvic floor and specifically, to the pudendal nerve branch of the dorsal nerve to the penis.

Wow, that is amazing! Terrible for you but what a fantastic MRI. Was that done in Phoenix by Dr. Hibner's radiologist? It's a Dr. Kal something? I'm about to have an MRI done there in a week and a half.
Kate

Hi Tiny Dancer,
This was done by Dr. Hollis Potter in New York city at Hospital for Special surgery.Her link is as follows.She is the only one who can visualize the whole path of the Pudendal Nerve.
http://www.pudendalhope.org/node/58#Potter

Dr. Olga Kalinkin does the angiogram of the Pudendal artery to my knowledge.My appointment got postponed because she went on a vacation next week.I am scheduled now to have the test with her on the 26th and an appointment with Dr. Hibner on the 27th of October at 9:30 am.

I have already done my angiogram with Dr. Kim at Boston Medical College.I would like to compare both their results.
Take care,
Ali

Ali,

I have an appointment with Dr. Kalinkin on Oct. 19th for an MRI. I talked to Dr. Hibner about the 3T MRI that Dr. Potter does and he said he didn't like that one. He said that Dr. Kalinkin was able to do it with her MRI machine. He even rejected the MRI and MRN that I brought from Virginia. Dr. Olga Kalinkin is a radiologist and runs more tests than angiograms.
Kat

Hi Tiny Dancer,
It would be interesting to see what Dr. Olga's Kalinkin MRI results come out to be and what her other tests are about?.Will they match with Dr. Potter's findings.
By the way,Dr. Hibner has already seen my MRI report from Dr. Potter and has asked me to bring the images for review.If Dr. Olga Kalinkin or Dr. Hibner have any doubts about the images or report by Dr. Potter and then they should get in contact with her and discuss my case with her.She is ready to discuss any PNE patient's MRI reports and images with any radialogist or PNE surgeon.
I am looking forward to meeting Dr. Kalinkin and especially Dr. Hibner once again.Hopefully,this nightmare will come to an end and I can get along with my life.


Take care,
Ali

Hi Tiny Dancer,
Who did your tests in Virginia?Were they done by 1.5 Tesla MRI or 3 Tesla MRI.

Thanks,
Ali

When docs are saying they dont like an MRI done by Hollis Potter how can they say that - its a series of images- different doctors may interpret differently but my money is on Hollis Potter. Anyway the images should be discussed doctor to doctor, not commented on negatively to the patient
Interestingly Dr Potter mentioned Ali's hamstrings where they join ischial tuberosities presumably because they are degenerated. This is just about the most common cause of sitting pain particularly when main symptom eg no pain in other areas such as vagina, penis etc/ Its like sitting on rocks and this or some form of it is what I have. On MRI nothing shows, on ultrasound it does! I am thinking of seeing Hollis Potter for a really definitive MRI to make sure I dont have any other complications. I am just so impressed with what she is turning out but I think its essential to try and see her for a discussion
Hilary

Hi Hilary,
I'm hoping you can help me with something (or anyone else who may know):

hilary wrote:Interestingly Dr Potter mentioned Ali's hamstrings where they join ischial tuberosities presumably because they are degenerated. This is just about the most common cause of sitting pain particularly when main symptom eg no pain in other areas such as vagina, penis etc/ Its like sitting on rocks and this or some form of it is what I have.

I developed "sit bone" pain after my 2nd round of nerve blocks. And that's exactly what it feels like! Like I'm sitting on large, sharp rocks. However, I do have all the other classic symptoms, as well. So, this is caused by what? Hamstrings? Ischial tuberosities (what does that mean)? Does it go away? I too had the 3T MRI, read by Potter. I don't think it mentioned anything about this particular symptom. Maybe we should start a "Sit bone pain" thread?
Thanks for any light you can shed ...
Warm regards,
Karyn

Hi Hilary and Karyn,
I also had blocks into the ischial bursitis by Dr. Noor Gajraj and it didn't bring any relief last year.It is very interesting to know that I developed the same pain on both sides after my PN nerve block with Dr. Quesada in NH in August,2007.I still have that pain even 8 months after my surgery with Dr.Bautrant.That pain has never left me.

Thanks,
Ali

Hi Ali,
Yes, I had my blocks done by Dr. Quesada, too. But do you know what happened? Do you know why we have "sit bone" pain, now?
Warm regards,
Karyn