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Pelvic floor imaging: comparison between magnetic resonance imaging and conventional defecography in studying outlet obstruction syndrome

Imaging del pavimento pelvico: confronto fra risonanza magnetica e defecografia tradizionale nello studio della sindrome da defecazione ostruita

  • Abdominal Radiology / Radiologia Addominale
  • Published:
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Abstract

Purpose

This study prospectively compared the diagnostic capabilities of magnetic resonance (MR) imaging with conventional defecography (CD) in outlet obstruction syndrome.

Materials and methods

Nineteen consecutive patients with clinical symptoms of outlet obstruction underwent pelvic MR examination. The MR imaging protocol included static T2-weighted fast spin-echo (FSE) images in the sagittal, axial and coronal planes; dynamic midsagittal T2-weighted single-shot (SS)-FSE and fast imaging employing steady-state acquisition (FIESTA) cine images during contraction, rest, straining and defecation. MR images (including and then excluding the evacuation phase) were compared with CD, which is considered the reference standard.

Results

Comparison between CD and MR with evacuation phase (MRWEP) showed no significant differences in sphincter hypotonia, dyssynergia, rectocele or rectal prolapse and significant differences in descending perineum. Comparison between CD and MR without evacuation phase (MRWOEP) showed no significant differences in sphincter hypotonia, dyssynergia or enterocele but significant differences in rectocele, rectal prolapse and descending perineum. Comparison between MRWEP and MRWOEP showed no significant differences in sphincter hypotonia, dyssynergia, enterocele or descending perineum but significant differences in rectocele, rectal prolapse, peritoneocele, cervical cystoptosis and hysteroptosis.

Conclusions

MR imaging provides morphological and functional study of pelvic floor structures and may offer an imaging tool complementary to CD in multicompartment evaluation of the pelvis. An evacuation phase is mandatory.

Riassunto

Obiettivo

Scopo del presente lavoro è stato confrontare prospettivamente le capacità diagnostiche della risonanza magnetica (RM) con quelle della defecografia tradizionale (DT) nello studio della sindrome da defecazione ostruita.

Materiali e metodi

Diciannove pazienti consecutivi con defecazione ostruita sono stati sottoposti ad RM della pelvi. Sono state acquisite sequenze statiche fast spin echo (FSE)-T2-pesate sui piani sagittale, assiale e coronale e sequenze dinamiche single shot fast spin echo (SSFSE) e fast imaging employing steady-state acquisition (FIESTA) sul piano sagittale mediano durante contrazione dello sfintere anale, riposo, ponzamento, defecazione. Le immagini RM (prima includendo, poi escludendo la fase di evacuazione) sono state confrontate con la DT considerata come standard di riferimento.

Risultati

Il confronto DT vs RM con fase di evacuazione (RMCE) ha evidenziato differenze statisticamente non significative nell’ipotonia sfinteriale, dissinergia, rettocele, prolasso rettale, enterocele e differenze significative nel perineo discendente. Il confronto DT vs RM senza fase di evacuazione (RMSE) ha evidenziato differenze non significative nell’ipotonia sfinteriale, dissinergia, enterocele e differenze significative nel rettocele, prolasso rettale, perineo discendente. Il confronto RMCE vs RMSE ha evidenziato differenze non significative nell’ipotonia sfinteriale, dissinergia, enterocele, perineo discendente e differenze significative nel rettocele, prolasso rettale, peritoneocele, cervicocistoptosi, isteroptosi.

Conclusioni

La RM consente di effettuare uno studio morfologico e funzionale del pavimento pelvico; può rappresentare un esame complementare alla DT nella valutazione multicompartimentale della pelvi. La fase di evacuazione è fondamentale.

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Authors and Affiliations

  1. Istituto di Radiologia, Azienda Ospedaliero-Universitaria “Policlinico-Vittorio Emanuele”, P.O. “Gaspare Rodolico” di Catania, Via Santa Sofia 78, 95123, Catania, Italy

    P. V. Foti, R. Farina, G. Riva, M. Coronella, E. Fisichella, S. Palmucci, G. Politi & G. C. Ettorre

  2. Dipartimento di Scienze Chirurgiche, Azienda Ospedaliero-Universitaria “Policlinico-Vittorio Emanuele”, P.O. “Gaspare Rodolico” di Catania, Catania, Italy

    A. Racalbuto

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  1. P. V. Foti
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Foti, P.V., Farina, R., Riva, G. et al. Pelvic floor imaging: comparison between magnetic resonance imaging and conventional defecography in studying outlet obstruction syndrome. Radiol med 118, 23–39 (2013). https://doi.org/10.1007/s11547-012-0840-8

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  • DOI: https://doi.org/10.1007/s11547-012-0840-8

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