Can three-dimensional endoanal ultrasonography detect external anal sphincter atrophy? A comparison with endoanal magnetic resonance imaging

Abstract

Three-dimensional EUS and endoanal MRI are comparable for detecting EAS defects. However, correlation between the two methods for EAS thickness, length and area is poor. This is also the case for EAS volume determined on 3D EUS and EAS thickness and area measured on endoanal MRI. Three-dimensional EUS can be used for detecting EAS defects, but no 3D EUS measurements are suitable parameters for assessing EAS atrophy.

Evaluation of outcome of anorectal anomaly in childhood: the role of anorectal manometry and endosonography

“…The EAS along with pelvic floor muscles contribute to maintaining the urge faecal continence. ES may not reliably show the defects of EAS, which may be better defined by MRI and CT scan [1,33,49]. Our results indicate the necessity to preserve the IAS at operations for anorectal and cloacal anomalies, which has been recommended by some authors but it is still not generally heeded [37][38][39][40]42].…”

“…The detrimental effect of neuropathy on bowel and bladder function has been investigated by ARM and urodynamic studies in children with spinal cord lesions who have morphologically intact anal sphincters [33,46,47]. Agnarsson and others reported a reduced mean anal resting sphincter pressure, a short functional anal canal, impaired sensory/motor activities of the rectum and abnormal RAIR in neuropathic children with myelomeningocele compared to age-matched controls [46,47].…”

The role of three-dimensional endoluminal ultrasound imaging in the evaluation of anorectal diseases: a review

“…The results showed that agreement between 3D-EUS and E-MRI for the detection of sphincter defects was high: 61% for IAS defects (7 patients with 3D-EUS vs 8 patients with E-MRI) and 88% for EAS defects (14 patients with 3D-EUS vs 16 patients with E-MRI). However, when sphinter atrophy was analyzed, correlation between the two methods for EAS thickness (anterior, left, posterior, and right measurements), length, area, and volume was poor (EAS atrophy was seen in all patients on E-MRI) [12]. Measurements of EAS volume did not provide additional information on the quality of the EAS in incontinent patients.…”

“…Sphincter atrophy is defined as an extreme thinning of the sphincter fibers or a generalized fatty infiltration [12,13]. Findings have shown that this condition is associated with poor outcome of a sphincter repair and thus can be used as an important guide for the selection of patients eligible for surgery [13].…”

Do Changes in Anal Sphincter Anatomy Correlate With Anal Function in Women With a History of Vaginal Delivery?

“…These results are consistent with those of previous studies (2,22) , but all these measurements are relevant to therapeutic decision making, as ultrasound can differentiate between incontinent patients with intact anal sphincters and those with sphincter lesions, as well as associate anal pressures and symptoms, providing additional value to select patients for different treatment modalities. Fecal incontinence is multifactorial; different mechanisms are involved (12) and patients with fecal incontinence and intact sphincter may have muscle degeneration, atrophy, or pudendal neuropathy (19,23,25) . Ultrasound can identify clinically occult anal sphincter injuries following vaginal delivery (8,16) .…”