Predictive Value of Impaired Evacuation at Proctography in Diagnosing  Anismus

Halligan, Steve; Malouf, Andrew J.; Bartram, Clive I.; Marshall, M; Hollings, Nicholas; Kamm, Michael A.

doi:10.2214/ajr.177.3.1770633

Cited by 84 publications

(42 citation statements)

References 26 publications

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“…Impaired evacuation is highly suggestive for the presence of dyssynergic defecation. In accordance with the results of two studies by Halligan et al [8,9], the findings of the present study have also shown that impaired evacuation is the most frequent finding in patients with dyssynergic defecation. However, impaired evacuation yielded a low specificity and low PPV for the presence of dyssynergic defecation because it was also seen in patients of the control group.…”

Section: Discussionsupporting

confidence: 93%

“…Compared with asymptomatic volunteers, patients with dyssynergic defecation demonstrate delayed initiation of evacuation and impaired evacuation [9]. Impaired evacuation is highly suggestive for the presence of dyssynergic defecation.…”

Section: Discussionmentioning

confidence: 94%

“…Functional imaging with conventional defecography is considered to be a useful adjunct in establishing the diagnosis of dyssynergic defecation. Delayed initiation of evacuation and impaired evacuation in particular, as seen on conventional defecography, are highly predicitive for the presence of dyssynergic defecation [8,9]. Different structural imaging findings in conventional defecography have been described in patients with dyssynergic defecation; however, the usefulness of these findings is discussed controversially [8,10,11].…”

mentioning

confidence: 99%

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MR defecography in patients with dyssynergic defecation: spectrum of imaging findings and diagnostic value

Reiner¹,

Tutuian²,

Solopova³

et al. 2011

BJR

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Objectives: We describe the spectrum of findings and the diagnostic value of MR defecography in patients referred with suspicion of dyssynergic defecation. Methods: 48 patients (34 females, 14 males; mean age 48 years) with constipation and clinically suspected dyssynergic defecation underwent MR defecography. Patients were divided into patients with dyssynergic defecation (n518) and constipated patients without dyssynergic defecation (control group, n530). MRIs were analysed for evacuation ability, time to initiate evacuation, time of evacuation, changes in the anorectal angle (ARA-change), presence of paradoxical sphincter contraction and presence of additional pelvic floor abnormalities. Sensitivity, specificity, positive and negative predictive values and accuracy for the diagnosis of dyssynergic defecation were calculated. Results: The most frequent finding was impaired evacuation, which was seen in 100% of patients with dyssynergic defecation and in 83% of the control group, yielding a sensitivity for MR defecography for the diagnosis of dyssynergic defecation of 100% (95% confidence interval (CI) 97-100%), but a specificity of only 23% (95% CI 7-40%). A lower sensitivity (50%; 95% CI 24-76%) and a high specificity (97%; 95% CI 89-100%) were seen with abnormal ARA-change. The sensitivity of paradoxical sphincter contraction was relatively high (83%; 95% CI 63-100%). A combined analysis of abnormal ARA-change and paradoxical sphincter contraction allowed for the detection of 94% (95% CI 81-100%) of the patients with dyssynergic defecation. Conclusion: MR defecography detects functional and structural abnormal findings in patients with clinically suspected dyssynergic defecation. Impaired evacuation is seen in patients with functional constipation owing to other pelvic floor abnormalities than dyssynergic defecation.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 94%

mentioning

confidence: 99%

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MR defecography in patients with dyssynergic defecation: spectrum of imaging findings and diagnostic value

Reiner¹,

Tutuian²,

Solopova³

et al. 2011

BJR

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“…27 Retention of more than two-third of the gel at the end of the MRI was incomplete evacuation. 28 Statistical analysis was performed using StatsDirect (Cheshire, UK) software. Accuracy of ultrasound was calculated by comparison with MRI.…”

Section: Dyssynergymentioning

confidence: 99%

Accuracy of integrated total pelvic floor ultrasound compared to defaecatory MRI in females with pelvic floor defaecatory dysfunction

Hainsworth¹,

Pilkington²,

Grierson³

et al. 2016

The British Journal of Radiology

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Cite this article as:Hainsworth AJ, Pilkington SA, Grierson C, Rutherford E, Schizas AMP, Nugent KP, et al. Accuracy of integrated total pelvic floor ultrasound compared to defaecatory MRI in females with pelvic floor defaecatory dysfunction. Objective: Defaecatory MRI allows multicompartmental assessment of defaecatory dysfunction but is often inaccessible. Integrated total pelvic floor ultrasound (transperineal, transvaginal, endoanal) may provide a cheap, portable alternative. The accuracy of total pelvic floor ultrasound for anatomical abnormalities when compared with defaecatory MRI was assessed. Methods: The dynamic images from 68 females who had undergone integrated total pelvic floor ultrasound and defaecatory MRI between 2009 and 2015 were blindly reviewed. The following were recorded: rectocoele, enterocoele, intussusception and cystocoele. Results: There were 26 rectocoeles on MRI (49 rectocoeles on ultrasound), 24 rectocoeles with intussusception on MRI (19 rectocoeles on ultrasound), 23 enterocoeles on MRI (24 enterocoeles on ultrasound) and 49 cystocoeles on MRI (35 cystocoeles on ultrasound). Sensitivity and specificity of total pelvic floor ultrasound were 81% and 33% for rectocoele, 60% and 91% for intussusception, 65% and 80% for enterocoele and 65% and 84% for cystocoele when compared with defaecatory MRI. This gave a negativepredictive value and positive-predictive value of 74% and 43% for rectocoele, 80% and 79% for intussusception, 82% and 63% for enterocoele and 48% and 91% for cystocoele. Conclusion: Integrated total pelvic floor ultrasound may serve as a screening tool for pelvic floor defaecatory dysfunction; when normal, defaecatory MRI can be avoided, as rectocoele, intussusception and enterocoele are unlikely to be present. Advances in knowledge: This is the first study to compare integrated total pelvic floor ultrasound with defaecatory MRI. The results support the use of integrated total pelvic floor ultrasound as a screening tool for defaecatory dysfunction.

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“…Evacuation time longer than 30 s is highly predictive of dyskinetic puborectalis muscle syndrome (20).…”

Section: Dyskinetic Puborectalis Muscle Syndromementioning

confidence: 99%

Defecography: a practical approach

Faccioli¹,

Comai²,

Mainardi³

et al. 2009

Diagn Interv Radiol

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The purpose of this pictorial essay is to describe the main morpho-functional imaging features, physiological and pathological, of the recto-anal region and pelvic floor as depicted with conventional video defecography.Defecography has dramatically improved our knowledge of dysfunctions of evacuation. The most frequent indications and related disorders are presented from a database of more than 2500 examinations conducted in two radiology departments over a period of 15 years.Imaging features of the common recto-anal and pelvic floor disorders are described: rectal prolapse, rectocele, intussusception, descending pelvic floor syndrome, puborectalis muscle syndrome, enterocele, and sigmoidocele. Conventional video defecography still represents the gold standard examination for the identification and staging of morphological and functional disorders of the recto-anal region and pelvic floor in evacuation dysfunctions.

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Predictive Value of Impaired Evacuation at Proctography in Diagnosing Anismus

Cited by 84 publications

References 26 publications

MR defecography in patients with dyssynergic defecation: spectrum of imaging findings and diagnostic value

MR defecography in patients with dyssynergic defecation: spectrum of imaging findings and diagnostic value

Accuracy of integrated total pelvic floor ultrasound compared to defaecatory MRI in females with pelvic floor defaecatory dysfunction

Defecography: a practical approach

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