[Show abstract][Hide abstract] ABSTRACT: To retrospectively evaluate magnetic resonance (MR) defecography findings in patients with fecal incontinence who were evaluated for surgical treatment and to assess the influence of MR defecography on surgical therapy.
Institutional review board approval was obtained. Informed consent was waived; however, written informed consent for imaging was obtained. Fifty patients (44 women, six men; mean age, 61 years) with fecal incontinence were placed in a sitting position and underwent MR defecography performed with an open-configuration MR system. Midsagittal T1-weighted MR images were obtained at rest, at maximal contraction of the sphincter, and at defecation. Images were prospectively and retrospectively reviewed by two independent observers for a variety of findings. Interobserver agreement was analyzed by calculating kappa statistics. Prospective interpretation of MR defecography findings was used to influence surgical therapy, and retrospective interpretation was used for concomitant pelvic floor disorders.
MR defecography revealed rectal descent of more than 6 cm (relative to the pubococcygeal line) in 47 (94%) of 50 patients. A bladder descent of more than 3 cm was present in 20 (40%) of 50 patients, and a vaginal vault descent of more than 3 cm was present in 19 (43%) of 44 women. Moreover, 17 (34%) anterior proctoceles, 16 (32%) enteroceles, and 10 (20%) rectal prolapses were noted. Interobserver agreement was good to excellent (kappa = 0.6-0.91) for image analysis results. MR defecography findings led to changes in the surgical approach in 22 (67%) of 33 patients who underwent surgery.
MR defecography may demonstrate a variety of abnormal findings in patients who are considered candidates for surgical therapy for fecal incontinence, and the findings may influence the surgical treatment that is subsequently chosen. Supplemental material: http://radiology.rsnajnls.org/cgi/content/full/2402050648/DC1
[Show abstract][Hide abstract] ABSTRACT: PURPOSE
Apart from the clinical evaluation, current diagnostic tests in the assessment of fecal incontinence (FI) includes anorectal ultrasound, anal manometry and reflexes. The use of MR defecography in this setting is less clear. The purpose of this study was to review the imaging findings of MR defecography in patients with fecal incontinence and to assess its impact on surgical management.
METHOD AND MATERIALS
50 consecutive patients (44 f, 6 m) referred to a tertiary center for physiological assessment and surgical treatment of their FI were included in this study. All patients underwent as part of the assessment of FI MR defecography in a sitting position using a open-configuration MR system. Beside clinical examination all pts were investigated by anorectal ultrasound, anal pressures, rectal sensitivity, anocutaneous and rectoanal inhibitory reflexes. MR defecography was performed after a rectal enema with midsagittal T1-w GRE images with the patient sitting while at rest, maximally contracting the sphincter, and defecating. MR defecographies were interpreted prospectively and retrospectively by two independent observers. Patients charts were reviewed to assess the impact of MR defecography on surgical management including those who were treated with sacral nerve stimulation.
MR defecography revealed rectal descent of >6 cm (relative to the pubo-coccygeal line) in 47 of 50 patients (94%). A vaginal vault descent of >3 cm was present in 19 patients (38%), and a bladder descent of > 3cm in 20 patients (40%). In addition, 17 anterior rectoceles of >2cm in sagittal diameter (34%), 16 enteroceles of >3cm (36%), and 5 intussusceptions (10%) were found. Of the 32 patients who finally were treated surgically, MR defecography changed the surgical approach in 25 patients (78%). The interobserver agreement (kappa statistics) between prospective and retrospective review was substantial to almost perfect (0.6-1.0).
MR defecography reveals a wide spectrum of abnormal findings in patients with FI and modifies the surgical approach in patients who are considered to be candidates for surgical treatment.