Comparative effectiveness of imaging modalities for preoperative assessment of anorectal malformation in the pediatric population

Abstract

Objective: The aim of this study was to compare the accuracy of MRI, colostography/fistulography, and X-ray imaging modalities for preoperative diagnosis of anorectal malformations (ARMs) in pediatric patients. Methods: This retrospective analysis included a total of 84 pediatric patients with ARMs. Preoperative imaging findings were assessed by 2 radiologists and compared to surgical findings. Results: MRI identified anomalies of the spine in 25 of 84 patients (29.8%), anomalies of the genital system in 7 of 84 patients (8.3%), anomalies of the urinary system in 22 of 84 patients (26.2%), and underdeveloped sphincter muscle complex in 34 of 84 patients (40.5%). In the 44 subjects receiving both MRI and X-ray, MRI was more sensitive in detecting anomalies of spine (18/44 vs. 8/44; P = 0.002), and both correctly identified the distal end of the rectum in 77.3% (34/44) of the cases. In the 24 subjects receiving both MRI and colostography/fistulography, MRI was more accurate in identifying Pena's classification (22/24 vs. 15/24; P = 0.039). Distal end of the rectum was correctly identified in 75.0% (18/24) and 58.3% (14/24) of the cases (P = 0.125). Conclusions: MRI could clearly reveal fistula anatomy and associated anomalies of ARMs and should be routinely used for preoperative evaluation of ARMs. Type of study: Study of diagnostic test. Level of evidence: Level II.

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

“…The use of magnetic resonance imaging (MRI) for the preoperative assessment of patients with anorectal malformations (ARM) has increased in recent years [1] . In children with ARM, MRI provides detailed one-stop-shop information regarding the type of malformation, condition of the sphincter-complex, gynecological comorbidities, urological anomalies, presence of presacral masses, and caudal regression syndrome [2] .…”

Diphallia: a case report of a rare anomaly evaluated by magnetic resonance imaging

“…4 However, MRI can further depict other minor associated anomalies, as well as help to decide the surgical approach, as it permits evaluation of penile structures; in fact, comprehensive studies comparing MRI to other imaging techniques have already demonstrated its superiority, yielding greater accuracy. 14,15 Also, to determine which penis has the full functional capacity, the presence of two corpus cavernosum and one corpus spongiosum is decisive, as well as spermatic cords, as MRI demonstrated in our patient; such structures will determine which penis will be excised. In more complex cases, where there is only one corpus cavernosum in each penis, the joining of two corporal bodies with penile reconstruction has been reported.…”

Imaging of anorectal malformations: where are we now? Abdominal imaging task force of the European Society of Paediatric Radiology

“…More recent literature has moved away from the modified approach with promotion of a standard feed and sleep (“feed and wrap”) pelvic MRI without distending the distal colon loop or injecting into the perineal fistulas [ 6 , 14 ]. With either approach, MRI is advocated as a promising one-stop-shop modality, allowing assessment of not only the whole pelvic contents (particularly in females) and fistulas but also confidently excluding presacral masses, evaluating the spine, evaluating the perineal sphincter muscle complex (at least in older patients) and evaluating the renal tracts, in one sitting [ 8 , 17 – 20 ]. In two recent publications, conventional high-resolution pelvic MRI is reported to have a higher sensitivity at appropriately detecting the anatomy of the rectal pouch (above versus at versus below the pelvic floor) when compared to the traditional distal colostogram (the recognised gold standard being the surgical findings).…”