Dynamic MR defecography of the posterior compartment: Comparison with conventional X-ray defecography

Abstract

Dynamic MR defecography is equivalent to X-ray defecography for the diagnosis of abnormalities of the posterior compartment of the pelvic floor.

Systematic review with meta‐analysis: defecography should be a first‐line diagnostic modality in patients with refractory constipation

“…Rectocele has traditionally been defined as an outpouching of the rectal wall on defecation . A total of 17/41 studies defined a cut‐off of rectocele depth to establish the diagnosis: 2 cm (n = 9); 2.5 cm (n = 1); 3 cm (n = 4); or 4 cm (n = 3) . However, the approach adopted to calculate rectocele size during maximum straining has been detailed in only nine of these as: (a) the “maximum depth of the bulge beyond the expected and extrapolated line of the anterior rectal wall” (n = 2); the “distance between the maximal anterior outbulge” and (b) the “axis of the anal canal” (n = 2), or (c) “a line through aspect of anorectal junction” (n = 1), or “a line drawn parallel to the center of the anal canal during straining” (n = 2); d) “outpouching of the anterior rectal wall ahead of rectovaginal septum, persisting on incomplete evacuation” (n = 2) …”

“…The amount of contrast retained within the rectocele has been reported as a measure of clinical significance in only 9/41 studies …”

“…Among the 59 studies in patients with CC, diagnostic criteria and prevalence of functional abnormalities were provided in 42 (71%), based on either (a) (n = 22); (b) (n = 2); (c) (n = 2); (a + b) (n = 4); (a + c) (n = 7); (b + c) (n = 1); or (a + b+c) (n = 4) . Quantitative meta‐analysis of these studies, including four comparative (barium defecography vs MRID) studies, showed a pooled prevalence of 24.1% (95% CI, 20.2‐28.4) on barium defecography and 25.9 (14.1‐39.6) on MRID (Figure S6).…”

“…A total of five studies compared barium defecography with MRID. Barium defecography represented the reference standard in all studies, except one adopting the results obtained from the joint analysis of barium defecography and MRID as reference . Vitton et al compared the accuracy of dynamic anorectal endosonography and MRID with barium defecography as the reference standard in the diagnosis of pelvic floor disorders in 56 women with ED.…”

“…Defecography is a radiologic technique still considered as the reference standard for the assessment of pelvic floor anatomy and function, given its capability to dynamically evaluate the rectum (and other pelvic organs) during simulated defecation . Its particular advantage over BET and manometry is that it enables the characterisation of structural abnormalities .…”