Zusammenfassung
Hintergrund
Die Behandlung koloproktologischer Krankheitsbilder erfordert eine adäquate Diagnostik zur optimalen und ggf. interdisziplinären Therapieplanung. Eine detaillierte Anamneseerhebung mit Erfassung der führenden Symptomatik und eine körperliche Untersuchung können ergänzt werden durch verschiedene klinische, funktionelle und bildgebende diagnostische Modalitäten. Somit sind eine suffiziente Differenzialdiagnostik, eine Beurteilung des Erkrankungsausmaßes und die Evaluation potenzieller Therapieoptionen möglich.
Fragestellung
Es wird eine Übersicht über die Möglichkeiten der modernen radiologisch-funktionellen Bildgebung bzgl. koloproktologischer Fragestellungen gegeben und ihre Wertigkeit in der klinischen Routine beleuchtet.
Material und Methoden
Die Literatur zur funktionell-radiologischen Bildgebung koloproktologischer Krankheitsbilder wie chronisch-entzündliche/akute Darmerkrankungen, Tumorerkrankungen, Beckenbodenerkrankungen, Deszensus‑/Prolapspathologien, Stuhlentleerungsstörungen, wird ausgewertet.
Ergebnisse
In der modernen radiologischen Funktionsdiagnostik kommen routinemäßig fluoroskopische Modalitäten (Defäkographie, Kolonkontrast), die (kontrastmittelgestützte) Magnetresonanztomographie (MR-Defäkographie, Enterographie), Computertomographie (CT) sowie die Endosonographie zum Einsatz. Je nach bildgebender Modalität können spezielle Krankheitsbilder detektiert und objektiviert werden. Die MRT, CT und Endosonographie bieten im Vergleich zur Durchleuchtung den Vorteil einer zusätzlichen Weichteil- und Organdarstellung.
Schlussfolgerung
Je nach koloproktologischer Fragestellung können verschiedene funktionell-radiologische Bildgebungen mit unterschiedlicher Aussagekraft in Abhängigkeit der jeweiligen Pathologie in der klinischen Routine indiziert und eingesetzt werden.
Abstract
Background
An adequate diagnostic approach is needed for an optimal interdisciplinary treatment planning of coloproctological diseases. A comprehensive anamnesis focusing on the main symptoms and a physical examination can be supplemented by various clinical, functional and imaging diagnostic modalities. In this way sufficient differential diagnostics, an assessment of the extent of the disease and the evaluation of potential treatment options are possible.
Objective
An overview of the possibilities of modern functional radiological imaging methods with respect to coloproctological problems is provided and the value in the clinical routine is illuminated.
Material and methods
The literature on functional radiological imaging of coloproctological disease patterns (chronic inflammatory/acute bowel diseases, tumor diseases, pelvic floor diseases, descensus or prolapse of pelvic organs, defecation problems etc.) was evaluated.
Results
Contrast-enhanced fluoroscopy (defecography, contrast enema of the colon), (contrast-enhanced) magnetic resonance imaging (MRI defecography, enterography), computed tomography (CT) and endosonography are routinely used in modern radiological functional diagnostics. Depending on the imaging modality, special disease patterns can be detected and objectified. The MRI, CT and endosonography provide the advantage of better soft tissue and organ contrast compared to fluoroscopy-based modalities.
Conclusion
Depending on the underlying coloproctological problem, various functional radiological imaging techniques with different powers of detection can be indicated and implemented in the clinical routine, depending on the respective pathology.
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Literatur
Chatterji M, Fidler JL, Taylor SA et al (2021) State of the art MR enterography technique. Top Magn Reson Imaging 30:3–11
Chavoshi M, Mirshahvalad SA, Kasaeian A et al (2021) Diagnostic accuracy of magnetic resonance enterography in the evaluation of colonic abnormalities in Crohn’s disease: a systematic review and meta-analysis. Acad Radiol 28(Suppl 1):S192–S202
Chen X, Xiaojuan W, Zhang H et al (2017) Diagnostic value of the preoperatively detected radiological transition zone in Hirschsprung’s disease. Pediatr Surg Int 33:581–586
Christe A (2021) MR imaging diagnostics in proctology. Ther Umsch 78:522–527
Crosby EC, Husk KE (2021) Defecatory dysfunction. Obstet Gynecol Clin North Am 48:653–663
Dal Corso HM, D’elia A, De Nardi P et al (2007) Anal endosonography: a survey of equipment, technique and diagnostic criteria adopted in nine Italian centers. Tech Coloproctol 11:26–33
Dreyer PDA (2021) CT Colonography: for screening and monitoring disease. Radiol Technol 92:595–608
Friedrich C, Fajfar A, Pawlik M et al (2012) Magnetic resonance enterography with and without biphasic contrast agent enema compared to conventional ileocolonoscopy in patients with Crohn’s disease. Inflamm Bowel Dis 18:1842–1848
Ghahremani GG, Mittal RK (2021) Pulsion diverticula of the rectum: radiological diagnosis and clinical implications. J Med Imaging Radiat Oncol 65:286–292
Goetz A, Da Silva NPB, Moser C et al (2017) Clinical value of contrast enema prior to Ileostomy closure. Rofo 189:855–863
Grossi U, Heinrich H, Di Tanna GL et al (2021) Systematic characterization of defecographic abnormalities in a consecutive series of 827 patients with chronic constipation. Dis Colon Rectum 64:1385–1397
Gurland BH, Khatri G, Ram R et al (2021) Consensus definitions and interpretation templates for magnetic resonance imaging of defecatory pelvic floor disorders: Proceedings of the Consensus Meeting of the Pelvic Floor Disorders Consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the International Continence Society, the American Urogynecologic Society, the International Urogynecological Association, and the Society of Gynecologic Surgeons. Dis Colon Rectum 64:1184–1197
Herold ATSE (2019) Manual der Koloproktologie Bd. 1. De Gruyter,
Huang SG, Qian XS, Cheng Y et al (2021) Machine learning-based quantitative analysis of barium enema and clinical features for early diagnosis of short-segment Hirschsprung disease in neonate. J Pediatr Surg 56:1711–1717
Jorge JMNH-GA, Wexner SD (2001) Clinical applications and techniques of cinedefecography. Am J Surg 182:93–101
Lin T, Ye Z, Hu J et al (2021) A comparison of trans-fistula contrast-enhanced endoanal ultrasound and MRI in the diagnosis of anal fistula. Ann Palliat Med 10:9165–9173
Nuernberg D, Saftoiu A, Barreiros AP et al (2019) EFSUMB recommendations for gastrointestinal ultrasound part 3: endorectal, endoanal and perineal ultrasound. Ultrasound Int Open 5:E34–E51
Onay M, Erden A, Binboga AB et al (2021) Assessment of imaging features of Crohn’s disease with MR enterography. Turk J Gastroenterol 32:631–639
Ota Y, Matsui T, Ono H et al (2003) Value of virtual computed tomographic colonography for Crohn’s colitis: comparison with endoscopy and barium enema. Abdom Imaging 28:778–783
Paquette I, Rosman D, Sayed RE et al (2021) Consensus definitions and interpretation templates for fluoroscopic imaging of defecatory pelvic floor disorders: Proceedings of the Consensus Meeting of the Pelvic Floor Consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the International Continence Society, the American Urogynecologic Society, the International Urogynecological Association, and the Society of Gynecologic Surgeons. Tech Coloproctol 25:3–17
Regadas FS, Haas EM, Abbas MA et al (2011) Prospective multicenter trial comparing echodefecography with defecography in the assessment of anorectal dysfunction in patients with obstructed defecation. Dis Colon Rectum 54:686–692
Rubesin SLMS, Laufer I, Herlinger H (2000) Double-contrast barium enema examination technique. Radiology 215:642–650
Samarasekera DN, Wright Y, Lowndes RH et al (2008) Comparison of vector symmetry index and endoanal ultrasonography in the diagnosis of anal sphincter disruption. Tech Coloproctol 12:211–215
Scharitzer M, Koizar B, Vogelsang H et al (2020) Crohn’s disease: prevalence, MR features, and clinical significance of enteric and colonic sinus tracts. Eur Radiol 30:5358–5366
Schreyer AG, Paetzel C, Fürst A et al (2012) Dynamic magnetic resonance defecography in 10 asymptomatic volunteers. World J Gastroenterol 18:6836–6842
Schreyer AGLD, Koletzko S, Hoffmann JC, Preiß JC, Zeitz M, Stange E, Herrlinger KE (2010) Aktualisierte S 3‑Leitlinie zur Diagnostik des Morbus Crohn – radiologische Untersuchungstechniken. Fortschr Röntgenstr 182:116–121
Schwandner T, Hecker A, Hirschburger M et al (2011) Does the STARR procedure change the pelvic floor: a preoperative and postoperative study with dynamic pelvic floor MRI. Dis Colon Rectum 54:412–417
Sieczkowska-Golub J, Marcinska B, Dadalski M et al (2021) Usefulness of colon assessment by magnetic resonance enterography in pediatric patients with inflammatory bowel disease-retrospective case series. J Clin Med. https://doi.org/10.3390/jcm10194336
Sirin SKS, Schweiger B, Hahnemann ML, Forsting M, Lauenstein TC, Kinner S (2015) Magnetic resonance colonography including diffusion-weighted imaging in children and adolescents with inflammatory bowel disease: do we really need intravenous contrast? Invest Radiol. https://doi.org/10.1097/RLI.0000000000000092
Spada C, Hassan C, Bellini D et al (2020) Imaging alternatives to colonoscopy: CT colonography and colon capsule. European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline – Update 2020. Endoscopy 52:1127–1141
Stadelmaier UBB, Meyer M, Hohenberger W, Matzel KE (2000) Kann die Kontinenzfunktion nach Rektumresektion prognostiziert werden? Chirurg 71:932–938
Stuart A, Ignell C, Orno AK (2019) Comparison of transperineal and endoanal ultrasound in detecting residual obstetric anal sphincter injury. Acta Obstet Gynecol Scand 98:1624–1631
Varyani F, Samuel S (2019) Can Magnetic Resonance Enterography (MRE) replace ileo-colonoscopy for evaluating disease activity in Crohn’s disease? Best Pract Res Clin Gastroenterol 101621:38–39
Zbar AP (2001) Magnetic resonance imaging and the coloproctologist. Tech Coloproctol 5:1–7
Zbar AP, Wexner SD (2010) Coloproctology. Springer,
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N. Platz Batista da Silva und A. G. Schreyer geben an, dass kein Interessenkonflikt besteht.
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Platz Batista da Silva, N., Schreyer, A.G. Funktionell-radiologische Diagnostik in der Koloproktologie. coloproctology 44, 82–90 (2022). https://doi.org/10.1007/s00053-022-00598-w
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DOI: https://doi.org/10.1007/s00053-022-00598-w
Schlüsselwörter
- Bildgebung
- Magnetresonanztomographische Defäkographie
- Koloproktologie
- Kolonkontrast
- Endoanaler/endorektaler Ultraschall