Not yet reviewed by Pith; the record is open.

Background and Objective: Pelvic floor disorders are prevalent diseases and patient care remains difficult as the dynamics of the pelvic floor remains poorly known. So far, only 2D dynamic observations of straining exercises at excretion are available in the clinics and the understanding of three-dimensional pelvic organs mechanical defects is not yet achievable. In this context, we proposed a complete methodology for the 3D representation of the non-reversible bladder deformations during exercises, directly combined with synthesized 3D representation of the location of the highest strain areas on the organ surface. Methods: Novel image segmentation and registration approaches have been combined with three geometrical configurations of up-to-date rapid dynamic multi-slices MRI acquisition for the reconstruction of real-time dynamic bladder volumes. Results: For the first time, we proposed real-time 3D deformation fields of the bladder under strain from in-bore forced breathing exercises. The potential of our method was assessed on eight control subjects undergoing forced breathing exercises. We obtained average volume deviation of the reconstructed dynamic volume of bladders around 2.5\% and high registration accuracy with mean distance values of 0.4 $\pm$ 0.3 mm and Hausdorff distance values of 2.2 $\pm$ 1.1 mm. Conclusions: Immediately transferable to the clinics with rapid acquisitions, the proposed framework represents a real advance in the field of pelvic floor disorders as it provides, for the first time, a proper 3D+t spatial tracking of bladder non-reversible deformations. This work is intended to be extended to patients with cavities filling and excretion to better characterize the degree of severity of pelvic floor pathologies for diagnostic assistance or in preoperative surgical planning.