MRI in Evaluating Atrophy of the External Anal Sphincter in Patients with Fecal Incontinence

Terra, Maaike P.; Hulst, Victor P. M. van der; Deutekom, Marije; Dijkgraaf, Marcel G. W.; Bossuyt, Patrick M.; Dobben, Annette C.; Baeten, C. G. M. I.; Stoker, Jaap

doi:10.2214/ajr.05.0386

Cited by 60 publications

(45 citation statements)

References 41 publications

(77 reference statements)

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“…Intraobserver correlation of pelvic organ prolapse has been weak even in single-site studies (12). Moderate and moderate-to-good interobserver correlation of external anal sphincter atrophy on endoanal ( ϭ 0.53-0.56) and phased-array coil ( ϭ 0.55-0.80) MR imaging have been reported (15). Better interobserver correlation has been shown in other singlecenter studies (10,11).…”

mentioning

confidence: 96%

Reproducibility of Dynamic MR Imaging Pelvic Measurements: A Multi-institutional Study

Lockhart¹,

Fielding²,

Richter³

et al. 2008

Radiology

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Purpose:To assess the reproducibility of bone and soft-tissue pelvimetry measurements obtained from dynamic magnetic resonance (MR) imaging studies in primiparous women across multiple centers. Materials and Methods:All subjects prospectively gave consent for participation in this institutional review board-approved, HIPAA-compliant study. At six clinical sites, standardized dynamic pelvic 1.5-T multiplanar T2-weighted MR imaging was performed in three groups of primiparous women at 6 -12 months after birth: Group 1, vaginal delivery with anal sphincter tear (n ϭ 93); group 2, vaginal delivery without anal sphincter tear (n ϭ 79); and group 3, cesarean delivery without labor (n ϭ 26). After standardized central training, blinded readers at separate clinical sites and a blinded expert central reader measured nine bone and 10 soft-tissue pelvimetry parameters. Subsequently, three readers underwent additional standardized training, and reread 20 MR imaging studies. Measurement variability was assessed by using intraclass correlation for agreement between the clinical site and central readers. Acceptable agreement was defined as an intraclass correlation coefficient (ICC) of at least 0.7. Results:There was acceptable agreement (ICC range, Note: This copy is for your personal, non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, use the Radiology Reprints form at the end of this article. Pelvic floor symptoms are common in women after childbirth (1). Objective assessment of anatomic changes and structural pathologic indicators is an important adjunct in characterization of pelvic floor symptoms resulting from childbirth. Dynamic magnetic resonance (MR) imaging is used to assess pelvic organ prolapse (2-5); however, correlation of MR findings with physical examination and cystocolpoproctography results is variable (5-7). Defecography also has high interobserver variability (8). Measurement reproducibility is important to assess, whether in the research or the clinical setting, since it may affect management of patients with pelvic floor disorders.Previously, a few small single-center series or retrospective studies have shown variable interobserver reliability in characterizing specific anatomic findings of anal sphincter and pelvic structures demonstrated by using MR imaging (9-14). Intraobserver correlation of pelvic organ prolapse has been weak even in single-site studies (12). Moderate and moderate-to-good interobserver correlation of external anal sphincter atrophy on endoanal ( ϭ 0.53-0.56) and phased-array coil ( ϭ 0.55-0.80) MR imaging have been reported (15). Better interobserver correlation has been shown in other singlecenter studies (10,11). Beets-Tan et al (10) showed better interobserver correlation for the internal anal sphincter by using endoanal (intraclass correlation coefficient [ICC], 0.65) and phasedarray (ICC, 0.75) MR imaging. Keller et al (11) showed high interobserver correlation for bone measurements such as obstetric conjugate (ICC, 0.96...

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mentioning

confidence: 96%

Reproducibility of Dynamic MR Imaging Pelvic Measurements: A Multi-institutional Study

Lockhart¹,

Fielding²,

Richter³

et al. 2008

Radiology

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“…Two recent studies in 30 patients with faecal incontinence have shown that this technique, despite its inferior local spatial resolution, is comparable with endoanal MR imaging for the depiction of anal sphincter defects and EAS atrophy (Fig. 8) [68,69]. The interobserver agreement for assessing anal sphincter integrity is moderate for endoanal MR imaging and poor to fair for external phased array MR imaging [69,70].…”

Section: Mr Imagingmentioning

confidence: 93%

“…The intraobserver agreement for detecting anal sphincter defects ranged from fair to very good for endoanal MR imaging and external phased array MR imaging [69]. Only one study evaluated the observer reproducibility in assessing EAS atrophy with MR imaging and reported that the interobserver agreement was moderate for endoanal MR imaging and moderate to good for external phased array MR imaging [68]. The intraobserver agreement for detecting EAS atrophy was moderate to very good for endoanal MR imaging and fair to very good for external phased array MR imaging.…”

Section: Mr Imagingmentioning

confidence: 99%

“…The intraobserver agreement for detecting EAS atrophy was moderate to very good for endoanal MR imaging and fair to very good for external phased array MR imaging. The reproducibility of observations of a single observer for diagnosing defects or atrophy of the anal sphincter complex seems to be related to the level of experience of an observer with endoanal MR imaging and external phased array MR imaging, respectively [68,69]. Training will make radiologists more familiar with the changes in sphincter morphology that appear in patients with defects or atrophy and might improve reader performance for both MR imaging techniques.…”

Section: Mr Imagingmentioning

confidence: 99%

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The current role of imaging techniques in faecal incontinence

Terra

Stoker

2006

Eur Radiol

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Faecal incontinence is a common multifactorial disorder. Major causes of faecal incontinence are related to vaginal delivery and prior anorectal surgery. In addition to medical history and physical examination, several anorectal functional tests and imaging techniques can be used to assess the underlying pathophysiology and to guide treatment planning in faecal incontinent patients. Anorectal functional tests provide functional information, but the potential strength comes from combining test results. Imaging techniques, including defecography, endoanal sonography, and magnetic resonance (MR) imaging, provide structural information about the anorectal region with a direct clinical impact. The major role of imaging techniques in faecal incontinence is visualising the structural and functional integrity of the anal sphincter complex. Both two-dimensional endoanal sonography and endoanal MR imaging are accurate tools to depict anal sphincter defects. The major advantage of endoanal MR imaging is the accurate demonstration of external anal sphincter atrophy. Recent studies have suggested that external phased array MR imaging and three-dimensional endoanal sonography are also valuable tools in the diagnostic work up of faecal incontinence. Decisions about the preferred technique will mainly be determined by availability and local expertise. This article demonstrates the current role of tests, predominantly imaging tests, in the diagnostic work up of faecal incontinence.

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“…At present, it is understandable that sphincteroplasty has a place because of its ease of performance, its sustainable improvement in functional outcome (at least for a foreseeable 3-5 years) and its repeatability [14]. The first-line management of the known sphincter defect with SNS will have implications regarding the accuracy of external anal sphincter defect and atrophy imaging definition [15] and should see a reduction in the national number of sphincteroplasties over time [16]. This approach is also reflected in the disappearance of dynamic graciloplasty and the ABS-Acticon device as alternatives have become available and where the side-effects and reoperations required for device complications, infection and extrusion have proven unacceptable both to the specialists performing the surgery and to the patient market force.…”

Section: Introductionmentioning

confidence: 99%

The Italian Society of Colo-Rectal Surgery Annual Report 2010: an educational review

et al. 2012

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MRI in Evaluating Atrophy of the External Anal Sphincter in Patients with Fecal Incontinence

Cited by 60 publications

References 41 publications

Reproducibility of Dynamic MR Imaging Pelvic Measurements: A Multi-institutional Study

Reproducibility of Dynamic MR Imaging Pelvic Measurements: A Multi-institutional Study

The current role of imaging techniques in faecal incontinence

The Italian Society of Colo-Rectal Surgery Annual Report 2010: an educational review

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