Can sacral development as a marker for caudal regression help identify associated urologic anomalies in patients with anorectal malformation?

Vilanova-Sánchez, Alejandra; Reck, Carlos A.; Sebastião, Yuri V.; Fuchs, Molly; Halleran, Devin R.; Weaver, Laura; Bates, D. Gregory; Gasior, Alessandra C.; Maloof, Tassiana; Hoover, Erin; Jaggers, Jordan; Gagnon, Renae; Ching, Christina B.; DaJusta, Daniel; Jayanthi, Venkata R.; Levitt, Marc A.; Wood, Richard J.

doi:10.1016/j.jpedsurg.2018.03.018

Cited by 15 publications

(8 citation statements)

References 27 publications

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“…It may also have a predictive value in identifying associated urological anomalies. [3][4][5] . The "sacral-ratio" (SR) is an index value calculated based on the sacral length with anatomical landmarks on the pelvic bone.…”

Section: Introductionmentioning

confidence: 99%

Assessment of sacral ratio in patients with anorectal malformations: Can magnetic resonance imaging replace conventional radiograph?

Krois

Palmisani

Gröpel

et al. 2021

Journal of Pediatric Surgery

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Introduction: In patients with anorectal malformations (ARM), the sacral ratio (SR) serves as an established predictive marker for functional prognosis and is derived from conventional radiographs. More recently, magnetic resonance imaging (MRI) has emerged as a diagnostic alternative for preoperative/baseline assessment of patients with ARM. With this study we aimed to evaluate if the SR could be reliable be measured from MRI images and if it correlated to SR measurements obtained from radiographs. Methods: Two raters analyzed MRI data and conventional radiographs from thirty-one subjects ( n = 17 with ARM; n = 14 controls). We calculated intra-class correlation coefficients (ICCs) to test inter-rater reliability and applied paired t -tests to examine if SR parameters from MRI were comparable with those from pelvic radiograph. We further computed Pearson's correlation coefficients to test the linear relationship between SR calculated from MRI and conventional radiographs. Results: The ARM and control groups did not statistically differ in their age and weight on the day of the MRI scan. Reliability analysis revealed an excellent inter-rater agreement for SR from radiograph parameters with an intraclass correlation coefficient (ICC) of 0.94, respectively of 0.86 for MRI (frontal plane), and of 0.84 for MRI (sagittal plane). The correlation coefficient between SR calculated from the sagittal MRI and SR calculated from radiograph images was significant and high ( r = 0.80, P < 0.001). The SRs from MRI images did not significantly differ from SRs from radiographs, but were also not statistically equivalent. Conclusion:Our results demonstrate that the SR can be derived from MRI images with good inter-rater reliability. The SR value is marginal higher when calculated on MRI, presumably due to inclusion of cartilaginous yet unossified structures.

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Section: Introductionmentioning

confidence: 99%

Assessment of sacral ratio in patients with anorectal malformations: Can magnetic resonance imaging replace conventional radiograph?

Krois

Palmisani

Gröpel

et al. 2021

Journal of Pediatric Surgery

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“…Numerous researchers were devoted to connecting SR to predicting fecal incontinence (2)(3)(4) and the presence of tethered cord (5). Recent reports have shown that SR is associated with urinary tract anomalies and neurogenic bladder (3,6).…”

Section: Introductionmentioning

confidence: 99%

Sacral Curvature in Addition to Sacral Ratio to Assess Sacral Development and the Association With the Type of Anorectal Malformations

et al. 2021

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Introduction: Sacral ratio (SR) is currently the only measurement to quantitatively evaluate sacral development in patients with anorectal malformations (ARM). This study proposes sacral curvature (SC) as a new indicator to qualitatively assess the sacrum and hypothesizes that sacral development, both quantitatively and qualitatively, can be an indicator to predict the type of ARM. The study aims to investigate the difference of SR and SC between ARM types and the association with the type of ARM.Methods and Materials: This study was retrospectively conducted between August 2008 and April 2019. Male patients with ARMs were enrolled and divided into three groups based on the types of ARM: (1) rectoperineal fistulae, (2) rectourethral-bulbar fistulae, and (3) rectourethral-prostatic or rectobladder-neck fistulae. SC was measured in the sagittal views of an MRI or a lateral radiograph of the sacrum.Results: Included in the study were 316 male patients with ARMs. SRs were 0.73 ± 0.12, 0.65 ± 0.12, and 0.57 ± 0.12 in perineal, bulbar, and prostatic/bladderneck fistula, respectively (p < 0.01). The SCs in perineal fistulae and bulbar fistulae were significantly higher than that in prostatic/bladderneck fistulae (0.25 ± 0.04, 0.22 ± 0.14, and 0.14 ± 0.18, p < 0.01). When SR ≥ 0.779, there was an 89.9% of possibility that the child has a perineal fistula. When SR ≤ 0.490 and SC ≤ 0, the possibilities of the child having prostatic/bladderneck fistulae were 91.6 and 89.5%, respectively. SC < 0 was also noted in 27 (27.8%), 19 (10.5%), and no (0%) patients of prostatic/bladderneck, bulbar, and perineal fistulae (p < 0.01), respectively. Sacral defect was noted in 63% of patients with SC ≤ 0, compared to none with SC > 0 (p < 0.01).Conclusions: The higher the rectal level is in an ARM, the lower are the objective measurements of the sacrum. SC ≤ 0 is associated with sacral defects and implies a high likelihood of prostatic/bladderneck fistulae.

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“…Caudal regression (represented by sacral ratio) and tethered cord are associated with anorectal malformation and specifically with cloacal anomalies as is a poorly developed sacrum [9]. Tethered cord is present in 30% of the patients with cloaca [10].…”

Section: Discussionmentioning

confidence: 99%

Factors predicting the need for vaginal replacement at the time of primary reconstruction of a cloacal malformation

Vilanova-Sánchez

Halleran

Reck

et al. 2020

Journal of Pediatric Surgery

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Can sacral development as a marker for caudal regression help identify associated urologic anomalies in patients with anorectal malformation?

Cited by 15 publications

References 27 publications

Assessment of sacral ratio in patients with anorectal malformations: Can magnetic resonance imaging replace conventional radiograph?

Assessment of sacral ratio in patients with anorectal malformations: Can magnetic resonance imaging replace conventional radiograph?

Sacral Curvature in Addition to Sacral Ratio to Assess Sacral Development and the Association With the Type of Anorectal Malformations

Factors predicting the need for vaginal replacement at the time of primary reconstruction of a cloacal malformation

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