MR Defecography in Patients with Fecal Incontinence: Imaging Findings and Their Effect on Surgical Management

Hetzer, Franc; Andreisek, Gustav; Tsagari, Christina; Sahrbacher, Ulli; Weishaupt, Dominik

doi:10.1148/radiol.2401050648

Cited by 116 publications

(68 citation statements)

References 33 publications

(44 reference statements)

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“…However, only open-configuration MRI gives the images in a seated position. The assessment of pelvic motility in a seated position has already been achieved by MR defecography (13). Second, this study provided no intraindividual comparison.…”

Section: Discussionmentioning

confidence: 97%

Dynamic imaging of swallowing in a seated position using open‐configuration MRI

Honda

Hata

2007

Magnetic Resonance Imaging

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Purpose:To assess the feasibility of dynamic MRI of swallowing in a seated position using an open-configuration MRI scanner, and to compare its capacity for motion analysis around the pharyngeal wall with that of videofluorography. Materials and Methods:Six healthy individuals (four women and two men, mean age ϭ 31.4 Ϯ 7.5 years) were examined with an open-configuration MRI system using a fast spoiled gradient-recalled echo (SPGR) sequence. Dynamic imaging was performed while the subjects were in a seated position after they swallowed oral contrast medium from a cup. An oral and maxillofacial radiologist measured the motion of six structures: the hyoid bone (HB), larynx (LX), upper oropharynx (UOP), lower oropharynx (LOP), pharyngoesophageal segment (PES) behind the vocal folds, and upper esophagus (ESO). The measured motions were compared with reported values from videofluorography-based observations. Results:Open-configuration MRI depicted the anatomic structures related to swallowing (lip, tongue, soft palate, mandible, pharynx, HB, LX, and PES), and the course of the mylohyoid muscle (MM). The vertical and anteroposterior displacements of these structures did not differ significantly from those measured by videofluorography. Conclusion:Dynamic imaging of swallowing using openconfiguration MRI provides image information comparable to that obtained from videofluorography.

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Section: Discussionmentioning

confidence: 97%

Dynamic imaging of swallowing in a seated position using open‐configuration MRI

Honda

Hata

2007

Magnetic Resonance Imaging

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“…Hetzer et al noted that findings on MRI defecography led to changes in the surgical approach in 67% of patients who underwent surgery [17]. Correctly identifying the severity of defects in all compartments may lead to changes in surgical decision making and improve overall surgical success rates.…”

Section: Discussionmentioning

confidence: 99%

Midpubic Line to Stage Pelvic Organ Prolapse by MRI Defecography As Compared to POP-Q

Schachar¹

2014

OGIJ

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described as a landmark for MRI staging of pelvic organ prolapse. Fresh cadaver data has established the midpubic line as a reliable indicator of the clinical hymen, which is the landmark used for clinical scoring [4].Previous studies have shown MRI to demonstrate a more advanced degree of prolapse; however, none have attempted to establish POP-Q equivalent MRI scoring. The merging of clinical and radiological reference points would allow detailed compartmental comparison between clinical and MRI evaluation. AbstractObjective: To compare the degree of pelvic organ prolapse (POP) as measured by the pelvic organ prolapse quantification (POP-Q) system to the degree of prolapse as measured by magnetic resonance imaging (MRI) defecography and to merge clinical and radiologic terminology in reference to POP.Methods: A retrospective analysis of 29 patients who presented with POP and defecatory complaints and underwent MRI defecography (2008)(2009)(2010)(2011). POP-Q scores were recorded by two attending urogynecologists. A radiologist, blinded to the clinical POP-Q scores, measured the maximum prolapse of the anterior vagina, posterior vagina, and vaginal apex/cervix on each subject's MRI.Results: Prolapse as measured by MRI defecography was significantly more advanced as compared to the clinical POP-Q measurements in all three compartments studied. The differences were both statistically significant and potentially, clinically relevant. A mean difference of 2.0 centimeters ± 1.5 SD, 2.3 centimeters ± 2.7 SD, and 5.0 centimeters ± 2.0 SD was observed in the anterior, apical, and posterior vaginal compartments, respectively. Conclusion:The increased degree of prolapse as demonstrated by MRI defecography may change clinical decision making and surgical planning. Therefore, MRI defecography may be a valuable adjunct in the clinical assessment of POP. 2/5 Materials and MethodsThis retrospective study was conducted at North Shore University Hospital. Institutional review board approval was obtained. Thirty-six women presenting for assessment of POP, who required MRI defecography as part of their clinical assessment, constituted the study population. The senior authors examined all patients in the study using the standard guidelines for the POP-Q examination. The clinical exams and MRIs were performed prior to any intent of studying the relationship between MRI and the POP-Q examination. MRI TechniquePatients underwent MRI with a 1.5-T scanner (Signa Excite HDx; GE Healthcare, Milwaukee, WI) with an 8-channel phased array coil in the supine position. Patients administered a fleet enema in the morning and emptied their bladders prior to imaging. 60ml of sterile lubricating jelly (Triad Disposables, Inc, Mukwonago, WI) was instilled into the vagina. 200ml of lubricating ultrasound transmission gel (Aquasonic, Parker Laboratories, Inc, Fairfield, NJ) was instilled into the rectum.Following an initial three plane localizer sequence, sagittal images were obtained employing a steady-state acquisition (FIESTA=fast imaging employin...

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“…MRI As with defecography, dynamic MRI can be used to obtain images of all three compartments at rest, during pressing, and during contractions of the pelvic floor [17]. Dynamic MRI can be used to visualize complex and/or recurrent prolapse conditions [18,19] and is particularly suitable to assess internal rectal prolapse/ intussusception and rectal emptying or stool retention [20][21][22].…”

Section: Imagingmentioning

confidence: 99%

Diagnosis and Therapy of Female Pelvic Organ Prolapse. Guideline of the DGGG, SGGG and OEGGG (S2e-Level, AWMF Registry Number 015/006, April 2016)

Baeßler

Aigmüller

Albrich

et al. 2016

Geburtshilfe Frauenheilkd

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Ziel: Erstellung einer offiziellen, internationalen, interdisziplinären Leitlinie, publiziert und koordiniert von der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG). Die Leitlinie wurde für den deutschsprachigen Raum entwickelt und wird neben der DGGG auch von der Schweizerischen Gesellschaft für Gynäkologie und Geburtshilfe (SGGG) und der Österreichischen Gesellschaft für Gynäkologie und Geburtshilfe (OEGGG) mitgetragen. Das Ziel dieser Leitlinie, die von der DGGG publiziert und koordiniert wurde, ist es, durch die Evaluation der relevanten Literatur einen evidenzbasierten Überblick über die Diagnostik sowie konservative und operative Therapie des Descensus genitalis der Frau mit oder ohne Belastungsinkontinenz zu geben. Methoden: Es erfolgte ein systematischer Review sowie Synthese von Daten, anteilig mit Metaanalyse (S2e). Es wurde eine umfassende Literatursuche in MEDLINE, Embase, Cinahl, Pedro und im Cochrane-Register, in Referenzlisten und in den Abstracts der Annual Meetings der International Continence Society und der International Urogynecological Association durchgeführt. Abstracts wurden eingeschlossen, wenn es sich um randomisierte Studien handelte, die als Podiumpräsentation vorgestellt und diskutiert wurden. Es wurden Originalarbeiten seit 2008 eingeschlossen, deren Nachkontrollzeitraum bei mindestens 12 Monaten lag. Für die Beschreibung von perioperativen Komplikationen wurden jegliche Daten herangezogen. Empfehlungen: Es werden Empfehlungen zur Diagnostik, konservativen und operativen Therapie des Genitaldeszensus gegeben, wobei die 3 urogynäkologischen Kompartimente, Prävention oder Behandlung von Belastungsinkontinenz, Vor-und Nachteile von Netzaugmentationen sowie uteruserhaltende Optionen, berücksichtigt

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MR Defecography in Patients with Fecal Incontinence: Imaging Findings and Their Effect on Surgical Management

Abstract: http://radiology.rsnajnls.org/cgi/content/full/2402050648/DC1

Cited by 116 publications

References 33 publications

Dynamic imaging of swallowing in a seated position using open‐configuration MRI

Dynamic imaging of swallowing in a seated position using open‐configuration MRI

Midpubic Line to Stage Pelvic Organ Prolapse by MRI Defecography As Compared to POP-Q

Diagnosis and Therapy of Female Pelvic Organ Prolapse. Guideline of the DGGG, SGGG and OEGGG (S2e-Level, AWMF Registry Number 015/006, April 2016)

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