Atrophy and Defects Detection of the External Anal Sphincter: Comparison Between Three-Dimensional Anal Endosonography and Endoanal Magnetic Resonance Imaging |
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Authors: | Marcel Cazemier MD Maaike P Terra MD Jaap Stoker MD PhD Elly S M de Lange-de Klerk MD PhD Guy E E Boeckxstaens MD PhD Chris J J Mulder MD PhD Richelle J F Felt–Bersma MD PhD |
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Institution: | (1) Department of Gastroenterology and Hepatology, VU Medical Center, Amsterdam, The Netherlands;(2) Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands;(3) Department of Clinical Epidemiology & Biostatistics, VU Medical Center, Amsterdam, The Netherlands;(4) Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands;(5) VU Medical Center, De Boelelaan 1117, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands |
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Abstract: | Purpose Using endoanal magnetic resonance imaging, atrophy of the external anal sphincter can be established. This aspect has not
been thoroughly investigated using three-dimensional anal endosonography. The purpose of this study was to compare prospectively
three-dimensional anal endosonography to magnetic resonance imaging in the detection of atrophy and defects of the external
anal sphincter in patients with fecal incontinence. In addition, we compared both techniques for anal sphincter thickness
and length measurements.
Materials and Methods Patients with fecal incontinence underwent three-dimensional anal endosonography and magnetic resonance imaging. Images of
both endoluminal techniques were evaluated for atrophy and defects of the external anal sphincter. External anal sphincter
atrophy scoring with three-dimensional anal endosonography depended on the distinction of the external anal sphincter and
its reflectivity. External anal sphincter atrophy scoring with magnetic resonance imaging depended on the amount of muscle
and the presence of fat replacement. Atrophy score was defined as none, moderate, and severe. A defect was defined at anal
endosonography by a hypoechogenic zone and at magnetic resonance imaging as a discontinuity of the sphincteric ring and/or
scar tissue. Differences between three-dimensional anal endosonography and magnetic resonance imaging for the detection of
external anal sphincter atrophy and defects were calculated. In addition, we compared external anal sphincter thickness and
length measurements in three-dimensional anal endosonography and magnetic resonance imaging.
Results Eighteen patients were included (median age, 58 years; range, 27–80; 15 women). Three-dimensional anal endosonography and
magnetic resonance imaging did not significantly differ for the detection of external anal sphincter atrophy (P = 0.25) and defects (P = 0.38). Three-dimensional anal endosonography demonstrated atrophy in 16 patients, magnetic resonance imaging detected atrophy
in 13 patients. Three-dimensional anal endosonography agreed with magnetic resonance imaging in 15 of 18 patients for the
detection of external anal sphincter atrophy. Using the grading system, 8 of the 18 patients scored the same grade. Three-dimensional
anal endosonography detected seven external anal sphincter defects and magnetic resonance imaging detected ten. Three-dimensional
anal endosonography and magnetic resonance imaging agreed on the detection of external anal sphincter defects in 13 of 18
patients. Comparison between three-dimensional anal endosonography and magnetic resonance imaging for sphincter thickness
and length measurements showed no statistically significant concordance and had no correlation with external anal sphincter
atrophy.
Conclusion This is the first study that shows that three-dimensional anal endosonography can be used for detecting external anal sphincter
atrophy. Both endoanal techniques are comparable in detecting atrophy and defects of the external anal sphincter, although
there is a substantial difference in grading of external anal sphincter atrophy. Correlation between three-dimensional anal
endosonography and magnetic resonance imaging for thickness and length measurements is poor. Inconsistency between the two
methods needs to be evaluated further.
Supported in part by grant No. 945-01-013 from the Netherlands Organization for Health Research and Development.
Presented in part at the United European Gastroenterology Week, Prague, Czech Republic, September 25 to 29, 2004.
Reprints are not available. |
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Keywords: | Fecal incontinence External anal sphincter atrophy Anal endosonography Endoanal magnetic resonance imaging |
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