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

Abstract

Anorectal and cloacal malformations are a broad mix of congenital abnormalities related to the distal rectum and anus. Confusion exists between all the forms in this large and heterogeneous group. The spectrum includes everything from anal stenosis, ventral anus, anal atresia (with and without fistula) and the full spectrum of cloacal malformations. Imaging in these conditions is done through the whole armamentarium of radiologic modalities, with very different imaging strategies seen across the centres where these conditions are managed. In 2017, the European Society of Paediatric Radiology (ESPR) abdominal imaging task force issued recommendations on the imaging algorithm and standards for imaging anorectal malformations. This was followed by further letters and clarifications together with an active multispecialty session on the different imaging modalities for anorectal malformations at the 2018 ESPR meeting in Berlin. Through this paper, the abdominal task force updates its guidelines and recommended imaging algorithm for anorectal malformations.

Value of fetal pelvic ultrasound examination in diagnosis of anorectal malformation with rectobulbar fistula

“…In the presented case, a fistula was visualized in the rectal pouch prenatally, later confirmed as a rectolobular fistula on postnatal ultrasound. Figure 3 shows the common types of fistula associated with ARM as reported in the study of Stafrace et al 4 . who used T2‐weighted MRI in the sagittal view.…”

“…Our findings may aid parental counseling and guide clinical decisions made by a multidisciplinary team. P. T. Castro 1,2 , T. Fazecas 1 , A. P. P. Matos 1 , G. Ribeiro 1 , E. Araujo J únior 3,4 * and H. Werner…”

“…In neonates, perineal ultrasonography provides more anatomical information than does traditional radiographic methods and avoids unnecessary exposure to radiation. Furthermore, perineal ultrasonography can be performed in the first few days after delivery to verify the following features for proper malformation classification: (1) position of the rectal pouch; (2) presence or absence of a fistula; and (3) if present, the type and location of the fistula 4 . In the presented case, a fistula was visualized in the rectal pouch prenatally, later confirmed as a rectolobular fistula on postnatal ultrasound.…”

“…Figure3T2-weighted magnetic resonance imaging sequences in sagittal view of most common anorectal malformations with fistulas in male fetuses and children (according to study of Stafrace et al4 ).…”

Evaluating the utility of cystoscopy, distal colostography, and sonography for locating the fistula in patients with anorectal malformation: a case series

“…ARMs have an estimated prevalence of 2–6 in 10 000 births 2 . Anorectal anomalies are more commonly seen in male infants, whereas cloacal malformations are more prevalent in female infants 3 . About half of the patients with ARM have associated anomalies varying from genitourinary (40–50%), cardiovascular (30–35%), spinal cord (25–30%), gastrointestinal (5–10%), and VACTERL (vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula, renal anomalies, and limb abnormalities) (4–9%) anomalies 1 .…”