Spine evaluation in children with anorectal malformations

The value of radiography, ultrasound and magnetic resonance imaging (MRI) in detecting skeletal and intraspinal pathology was assessed in infants with anorectal malformations, and the need for spinal MRI examination in this group of patients was evaluated. Twenty-one infants were examined with radiography, ultrasound and MRI of the lower spine. The detection of skeletal and intraspinal abnormalities was compared for the three imaging modalities. Fifteen patients were normal in all three examinations. Radiography showed bony skeletal abnormalities in six children, although sometimes very subtle. By ultrasound both bony and cartilaginous malformations were detected in all six patients and by MRI in five patients. Five of the six children with skeletal abnormalities had intraspinal pathology, detected in all cases by ultrasound and MRI. However, the abnormalities were more clearly demonstrated by MRI than by ultrasound. Spinal radiographs must be examined carefully for abnormalities, because they can indicate the presence or absence of intraspinal pathology. Normal radiographic and sonographic appearance of spinal anatomy in children with anorectal malformation makes MRI superfluous, but if radiographs or ultrasound are abnormal, MRI should be used to accurately depict possible intraspinal pathology.