Prospective Assessment of Interobserver Agreement for Defecography in Fecal Incontinence

Dobben, Annette C.; Wiersma, T. G.; Janssen, Luuk M.; Vos, Rien de; Terra, Maaike P.; Baeten, C. G. M. I.; Stoker, Jaap

doi:10.2214/ajr.04.1387

Cited by 25 publications

(18 citation statements)

References 23 publications

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“…Dynamic magnetic resonance (MR) imaging is used to assess pelvic organ prolapse (2)(3)(4)(5); however, correlation of MR findings with physical examination and cystocolpoproctography results is variable (5)(6)(7). Defecography also has high interobserver variability (8). Measurement reproducibility is important to assess, whether in the research or the clinical setting, since it may affect management of patients with pelvic floor disorders.…”

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confidence: 99%

Reproducibility of Dynamic MR Imaging Pelvic Measurements: A Multi-institutional Study

Lockhart¹,

Fielding²,

Richter³

et al. 2008

Radiology

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Purpose:To assess the reproducibility of bone and soft-tissue pelvimetry measurements obtained from dynamic magnetic resonance (MR) imaging studies in primiparous women across multiple centers. Materials and Methods:All subjects prospectively gave consent for participation in this institutional review board-approved, HIPAA-compliant study. At six clinical sites, standardized dynamic pelvic 1.5-T multiplanar T2-weighted MR imaging was performed in three groups of primiparous women at 6 -12 months after birth: Group 1, vaginal delivery with anal sphincter tear (n ϭ 93); group 2, vaginal delivery without anal sphincter tear (n ϭ 79); and group 3, cesarean delivery without labor (n ϭ 26). After standardized central training, blinded readers at separate clinical sites and a blinded expert central reader measured nine bone and 10 soft-tissue pelvimetry parameters. Subsequently, three readers underwent additional standardized training, and reread 20 MR imaging studies. Measurement variability was assessed by using intraclass correlation for agreement between the clinical site and central readers. Acceptable agreement was defined as an intraclass correlation coefficient (ICC) of at least 0.7. Results:There was acceptable agreement (ICC range, Note: This copy is for your personal, non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, use the Radiology Reprints form at the end of this article. Pelvic floor symptoms are common in women after childbirth (1). Objective assessment of anatomic changes and structural pathologic indicators is an important adjunct in characterization of pelvic floor symptoms resulting from childbirth. Dynamic magnetic resonance (MR) imaging is used to assess pelvic organ prolapse (2-5); however, correlation of MR findings with physical examination and cystocolpoproctography results is variable (5-7). Defecography also has high interobserver variability (8). Measurement reproducibility is important to assess, whether in the research or the clinical setting, since it may affect management of patients with pelvic floor disorders.Previously, a few small single-center series or retrospective studies have shown variable interobserver reliability in characterizing specific anatomic findings of anal sphincter and pelvic structures demonstrated by using MR imaging (9-14). Intraobserver correlation of pelvic organ prolapse has been weak even in single-site studies (12). Moderate and moderate-to-good interobserver correlation of external anal sphincter atrophy on endoanal ( ϭ 0.53-0.56) and phased-array coil ( ϭ 0.55-0.80) MR imaging have been reported (15). Better interobserver correlation has been shown in other singlecenter studies (10,11). Beets-Tan et al (10) showed better interobserver correlation for the internal anal sphincter by using endoanal (intraclass correlation coefficient [ICC], 0.65) and phasedarray (ICC, 0.75) MR imaging. Keller et al (11) showed high interobserver correlation for bone measurements such as obstetric conjugate (ICC, 0.96...

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confidence: 99%

Reproducibility of Dynamic MR Imaging Pelvic Measurements: A Multi-institutional Study

Lockhart¹,

Fielding²,

Richter³

et al. 2008

Radiology

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“…Secondly, in spite of a standard protocol for defecography, inaccurate assessment of the rectocele by the radiologist must be considered. The interobserver agreement for posterior wall prolapse represented by point Bp of POP-Q [13]. A third explanation is that relaxation of the vaginal wall does not necessarily go together with bulging of anterior rectal wall, implying that posterior wall prolapse and rectocele are different anatomic disorders and not synonyms for the same condition [14].…”

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confidence: 99%

Correlation between posterior vaginal wall defects assessed by clinical examination and by defecography

et al. 2008

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To estimate the accuracy of clinical examination and the indications for defecography in patients with primary posterior wall prolapse. Fifty-nine patients with primary pelvic organ prolapse were evaluated with a questionnaire, clinical examination and defecography. Defecography was used as reference standard. There was no relation between bowel complaints and posterior wall prolapse evaluated by clinical examination (p = 0.33), nor between bowel complaints and rectocele (p = 0.19) or enterocele (p = 0.99) assessed by defecography. The diagnostic accuracy of clinical examination in diagnosing rectocele was 0.42, sensitivity was 1.0 and specificity was 0.23. The diagnostic accuracy of clinical examination in diagnosing enterocele was 0.73, with a sensitivity of 0.07 and a specificity of 0.95. Clinical examination is not accurate to assess anatomic defects of the posterior vaginal wall. Defecography is recommended as a helpful diagnostic tool in the work-up of patients with posterior vaginal wall prolapse if surgical repair is considered.

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“…anismus) cause [31]. A recent study reported that the reproducibility of diagnosing enterocele, anterior rectocele and their grading in patients with faecal incontinence is good [32]. Diagnosing intussusception and its severity seemed to be more difficult.…”

Section: Imaging Techniquesmentioning

confidence: 99%

The current role of imaging techniques in faecal incontinence

Terra

Stoker

2006

Eur Radiol

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Faecal incontinence is a common multifactorial disorder. Major causes of faecal incontinence are related to vaginal delivery and prior anorectal surgery. In addition to medical history and physical examination, several anorectal functional tests and imaging techniques can be used to assess the underlying pathophysiology and to guide treatment planning in faecal incontinent patients. Anorectal functional tests provide functional information, but the potential strength comes from combining test results. Imaging techniques, including defecography, endoanal sonography, and magnetic resonance (MR) imaging, provide structural information about the anorectal region with a direct clinical impact. The major role of imaging techniques in faecal incontinence is visualising the structural and functional integrity of the anal sphincter complex. Both two-dimensional endoanal sonography and endoanal MR imaging are accurate tools to depict anal sphincter defects. The major advantage of endoanal MR imaging is the accurate demonstration of external anal sphincter atrophy. Recent studies have suggested that external phased array MR imaging and three-dimensional endoanal sonography are also valuable tools in the diagnostic work up of faecal incontinence. Decisions about the preferred technique will mainly be determined by availability and local expertise. This article demonstrates the current role of tests, predominantly imaging tests, in the diagnostic work up of faecal incontinence.

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Prospective Assessment of Interobserver Agreement for Defecography in Fecal Incontinence

Cited by 25 publications

References 23 publications

Reproducibility of Dynamic MR Imaging Pelvic Measurements: A Multi-institutional Study

Reproducibility of Dynamic MR Imaging Pelvic Measurements: A Multi-institutional Study

Correlation between posterior vaginal wall defects assessed by clinical examination and by defecography

The current role of imaging techniques in faecal incontinence

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