Abstract
Purpose
This study prospectively compared the diagnostic capabilities of magnetic resonance (MR) imaging with conventional defecography (CD) in outlet obstruction syndrome.
Materials and methods
Nineteen consecutive patients with clinical symptoms of outlet obstruction underwent pelvic MR examination. The MR imaging protocol included static T2-weighted fast spin-echo (FSE) images in the sagittal, axial and coronal planes; dynamic midsagittal T2-weighted single-shot (SS)-FSE and fast imaging employing steady-state acquisition (FIESTA) cine images during contraction, rest, straining and defecation. MR images (including and then excluding the evacuation phase) were compared with CD, which is considered the reference standard.
Results
Comparison between CD and MR with evacuation phase (MRWEP) showed no significant differences in sphincter hypotonia, dyssynergia, rectocele or rectal prolapse and significant differences in descending perineum. Comparison between CD and MR without evacuation phase (MRWOEP) showed no significant differences in sphincter hypotonia, dyssynergia or enterocele but significant differences in rectocele, rectal prolapse and descending perineum. Comparison between MRWEP and MRWOEP showed no significant differences in sphincter hypotonia, dyssynergia, enterocele or descending perineum but significant differences in rectocele, rectal prolapse, peritoneocele, cervical cystoptosis and hysteroptosis.
Conclusions
MR imaging provides morphological and functional study of pelvic floor structures and may offer an imaging tool complementary to CD in multicompartment evaluation of the pelvis. An evacuation phase is mandatory.
Riassunto
Obiettivo
Scopo del presente lavoro è stato confrontare prospettivamente le capacità diagnostiche della risonanza magnetica (RM) con quelle della defecografia tradizionale (DT) nello studio della sindrome da defecazione ostruita.
Materiali e metodi
Diciannove pazienti consecutivi con defecazione ostruita sono stati sottoposti ad RM della pelvi. Sono state acquisite sequenze statiche fast spin echo (FSE)-T2-pesate sui piani sagittale, assiale e coronale e sequenze dinamiche single shot fast spin echo (SSFSE) e fast imaging employing steady-state acquisition (FIESTA) sul piano sagittale mediano durante contrazione dello sfintere anale, riposo, ponzamento, defecazione. Le immagini RM (prima includendo, poi escludendo la fase di evacuazione) sono state confrontate con la DT considerata come standard di riferimento.
Risultati
Il confronto DT vs RM con fase di evacuazione (RMCE) ha evidenziato differenze statisticamente non significative nell’ipotonia sfinteriale, dissinergia, rettocele, prolasso rettale, enterocele e differenze significative nel perineo discendente. Il confronto DT vs RM senza fase di evacuazione (RMSE) ha evidenziato differenze non significative nell’ipotonia sfinteriale, dissinergia, enterocele e differenze significative nel rettocele, prolasso rettale, perineo discendente. Il confronto RMCE vs RMSE ha evidenziato differenze non significative nell’ipotonia sfinteriale, dissinergia, enterocele, perineo discendente e differenze significative nel rettocele, prolasso rettale, peritoneocele, cervicocistoptosi, isteroptosi.
Conclusioni
La RM consente di effettuare uno studio morfologico e funzionale del pavimento pelvico; può rappresentare un esame complementare alla DT nella valutazione multicompartimentale della pelvi. La fase di evacuazione è fondamentale.
Article PDF
Similar content being viewed by others
Explore related subjects
Discover the latest articles, news and stories from top researchers in related subjects.Avoid common mistakes on your manuscript.
References/bibliografia
Bolog N, Weishaupt D (2005) Dynamic MR imaging of outlet obstruction Rom J Gastroenterol 14:293–302
Maglinte DD, Kelvin FM, Fitzgerald K et al (1999) Association of compartment defects in pelvic floor dysfunction. AJR Am J Roentgenol 172:439–444
Kelvin FM, Maglinte DD, Hale DS, Benson JT (2000) Female pelvic organ prolapse: a comparison of triphasic dynamic MR imaging and triphasic fluoroscopic cystocolpoproctography. AJR Am J Roentgenol 174:81–88
Mondot L, Novellas S, Senni M et al (2006) Pelvic prolapse: static and dynamic MRI. Abdom Imaging 32:775–783
Maubon A, Aubard Y, Berkane V et al (2003) Magnetic resonance imaging of the pelvic floor. Abdom Imaging 28:217–225
Fielding JR (2002) Practical MR imaging of female pelvic floor weakness. Radiographics 22:295–304
Roos JE, Weishaupt D, Wildermuth S et al (2002) Experience of 4 years with open MR defecography: pictorial review of anorectal anatomy and disease. Radiographics 22:817–832
Pannu HK, Kaufman HS, Cundiff GW et al (2000) Dynamic MR imaging of pelvic organ prolapse: spectrum of abnormalities. Radiographics 20:1567–1582
Hilfiker PR, Debatin JF, Schwizer W et al (1998) MR defecography: depiction of anorectal anatomy and pathology. J Comput Assist Tomogr 22:749–755
Kruyt RH, Delemarre JB, Doornbos J, Vogel HJ (1991) Normal anorectum: dynamic MR imaging anatomy. Radiology 179:159–163
Mortele KJ, Fairhurst J (2007) Dynamic MR defecography of the posterior compartment: Indications, techniques and MRI features. Eur J Radiol 61:462–472
Halligan S, Malouf A, Bartram CI et al (2001) Predictive value of impaired evacuation at proctography in diagnosing anismus. AJR Am J Roentgenol 177:633–636
Hecht EM, Lee VS, Tanpitukpongse TP et al (2008) MRI of pelvic floor dysfunction: dynamic true fast imaging with steady-state precession versus HASTE. AJR Am J Roentgenol 191:352–358
Yang A, Mostwin JL, Rosenheim NB, Zerhouni EA (1991) Pelvic floor descent in women: dynamic evaluation with fast MR imaging and cinematic display. Radiology 179:25–33
Torricelli P, Pecchi A, Caruso Lombardi A et al (2002) Magnetic resonance imaging in evaluating functional disorders of female pelvic floor. Radiol Med 103:488–500
Lienemann A, Anthuber C, Baron A et al (1997) Dynamic MR colpocystorectography assessing pelvic-floor descent. Eur Radiol 7:1309–1317
Vanbeckevoort D, Van Hoe L, Oyen R et al (1999) Pelvic floor descent in females: comparative study of colpocystodefecography and dynamic fast MR imaging. J Magn Reson Imaging 9:373–377
Lapray JF (2000) Imaging della vescica e della dinamica pelvica nella donna. Verduci Editore, Roma
Cappabianca S, Reginelli A, Iacobellis F et al (2011) Dynamic MRI defecography vs. entero-colpocystodefecography in the evaluation of midline pelvic floor hernias in female pelvic floor disorders. Int J Colorectal Dis 26:1191–1196
Shorvon PJ, Marshall MM (2005) Evacuation proctography. In: Wexner SD, Zbar AP, Pescatori M (eds) Complex anorectal disorders: investigation and management. Springer, Berlin Heidelberg New York, pp 171–198
Altringer WE, Saclarides TJ, Dominguez JM et al (1995) Four-contrast defecography: pelvic “flooroscopy”. Dis Colon Rectum 38:695–699
Zonca G, De Thomatis A, Marchesini R et al (1997) The absorbed dose to the gonads in adult patients undergoing defecographic study by digital or traditional radiographic imaging. Radiol Med (Torino) 94:520–523
Goei R, Kemerink G (1990) Radiation dose in defecography. Radiology 176:137–139
Fiaschetti V, Squillaci E, Pastorelli D et al (2011) Dynamic MR defecography with an open-configuration, low-field, tilting MR system in patients with pelvic floor disorders. Radiol Med 116:620–633
Lamb GM, de Jode MG, Gould SW et al (2000) Upright dynamic MR defaecating proctography in an open configuration MR system. BJR 73:152–155
Schoenenberger AW, Debatin JF, Guldenschuh I et al (1998) Dynamic MR defecography with a superconducting, open configuration MR system. Radiology 206:641–646
Bertschinger KM, Hetzer FH, Roos JE et al (2002) Dynamic MR imaging of the pelvic floor performed with patient sitting in an open-magnet unit versus with patient supine in a closed-magnet unit. Radiology 223:501–508
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Foti, P.V., Farina, R., Riva, G. et al. Pelvic floor imaging: comparison between magnetic resonance imaging and conventional defecography in studying outlet obstruction syndrome. Radiol med 118, 23–39 (2013). https://doi.org/10.1007/s11547-012-0840-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11547-012-0840-8