MRT zur Operationsplanung bei Analatresien

Abstract

We evaluated in this study the value of preoperative examinations of anal atresia with an optimised MRI strategy. 13 patients with anorectal anomalies, most of them younger than one year, underwent an MRI examination of the pelvis. 10 of these patients were operated afterwards. Compared with the situs shown by the operation the results of the MRI examination were very exact in all cases in respect of the level of atresia and the development of the striated muscle complex. Fistulas could be completely described in most cases. MRI demonstrated additional lesions in some patients which were of great importance for planning the further treatment of the patients. As a consequence MRI can give valid information on anal atresia for planning the operative treatment.

MR imaging of anorectal malformations and associated anomalies

“…9). Similar observations have been reported by Grebe et al [30]. To overcome this problem, Taccone et al introduced MRI after injection of vaseline oil into the distal loop of the colostomy, thus demonstrating the fistula prior to reconstructive surgery [28].…”

“…Multiplanar imaging capabilities and direct visualization of the rectal pouch and related musculature allow accurate determination of the level and type of anorectal malformations (Fig. 5) [20,24,28,30,31]. The level of anorectal malformation can be adequately depicted on T1-weighted images in most cases, but T2-weighted images are especially helpful in the evaluation of intermediate and low malformations, because the higher signal intensity of the anorectal mucosa allows better delineation of the anorectum with respect to the sphincter muscle complex and perineum ( Fig.…”

“…The sphincteric muscles can be very clearly demonstrated with MRI in multiple planes [18±21, 23±25, 28,30]. The levator ani muscle and puborectalis muscle, and their interrelationship with the external anal sphincter, are best evaluated on the coronal T1-weighted images, whereas the developmental state of the puborectalis muscle and external anal sphincter is more adequately visualized in the axial plane (Fig.…”

“…However, some remarks have to be made concerning MR imaging in children with anorectal malformations. Based on some recent reports, as well as from personal experiences, the optimal examination of these complex congenital malformations requires both spin-echo (SE) T1-weighted and (FSE) T2-weighted pulse sequences in multiple planes (Table 3) [6,30,31]. The sagittal plane includes pelvis, lumbar spine, and kidneys, whereas the axial and coronal planes initially are limited to the pelvis, and are angulated par- Spinal cord and Cauda Equina a Axial and coronal planes angulated parallel and perpendicular to pelvic floor, respectively (see Fig.…”

Proftologische Diagnostik

“…Zur präoperativen Einteilung der angeborenen anorektalen Anomalien nach der internationalen Klassifikation in hohe, mittlere und tiefe Atresien ist die MRT gut geeignet [43]. Die Untersuchung kann häufig auch Begleitmissbildungen aufdecken [44,45]. Verlaufskontrollen sind bei fehlender ionisierender Strahlung problemlos möglich.…”