Postoperative MRI evaluation of anorectal malformations with clinical correlation

Abstract

Sixteen postoperative patients with anorectal malformation were evaluated by MRI, and the results compared with the clinical assessment. Patients were classified into three groups--good (group 1, n = 10), fair (group 2, n = 3) and poor (group 3, n = 3)--on the basis of Kelly's clinical score of incontinence. The degree of development of the puborectalis and external sphincter muscles and the levator hammock was evaluated on MRI in comparison with patients without anorectal disease. The proportions of fair or poor development of the muscles were 37% in group 1,22% in group 2 and 67% in group 3. Although fair or poor development of the muscles was seen more frequently in group 3, there was no statistically significant difference between groups. However, poorly developed muscles were seen only in patients with fair or poor clinical scores. The difference in the anorectal angle measured on sagittal MRI images between patients in group 1 and groups 2 or 3 was significant. Our study indicates that MRI evaluation based solely on muscle development can be misleading, and measurement of the anorectal angle should be included in the MRI evaluation.

The Study of Fecal Incontinence in Post-Operative Anorectal Malformations – A Clinical Correlation With Mri Findings

“…[4,5] Misplaced neorectum can be detected easily by CT and MRI which probably is the most straight forward clinical application of these modalities. [6,7,8,9,10] In the studies of Fukuya et al [11] there were no patients with misplaced neorectum outside the levator ani muscle. But in the present study, 1 patient of high anorectal anomaly had misplaced neorectum for whom the Kelly's clinical score was poor and MRI scoring were assessed as fair.…”

“…According to the Fukuya et al [11] MRI scoring was given as Good if the sphincter muscles of the ARM patient showed the same degree of development as those without anorectal malformation, Fair if sphincter muscle was less developed and poor if sphincter muscles are not seen or barely identified.…”

“…Fukuya et al [11] compared his MRI scoring with the Kelly's scoring system of continence. They indicated that there was no significant difference in development of the muscle with fair and poor scores.…”

Magnetic Resonance Evaluation of Anorectal Malformation Cases Treated by Posterior Sagittal Anorectoplasty

“…6,7 Adequate placement of the neorectum not only through the puborectalis sling but also within the external sphincter is necessary for an adequate functional outcome after surgical correction of anorectal anomalies. 4 Several reports have assessed the efficacy of CT and MRI in evaluating anorectal malformation. 8,9,10,11 MRI with axial and coronal imaging has allowed direct visualization of the sphincter muscle complex with excellent anatomic detail due to its excellent soft tissue characterization.…”

“…2,3 It is superior to CT in identifying the sphincteric muscles due to its excellent soft tissue characterization. 4 …”