Skip to main content
SpringerLink
Log in

Atrophy and Defects Detection of the External Anal Sphincter: Comparison Between Three-Dimensional Anal Endosonography and Endoanal Magnetic Resonance Imaging

  • Published:
Diseases of the Colon & Rectum

Purpose

Using endoanal magnetic resonance imaging, atrophy of the external anal sphincter can be established. This aspect has not been thoroughly investigated using three-dimensional anal endosonography. The purpose of this study was to compare prospectively three-dimensional anal endosonography to magnetic resonance imaging in the detection of atrophy and defects of the external anal sphincter in patients with fecal incontinence. In addition, we compared both techniques for anal sphincter thickness and length measurements.

Materials and Methods

Patients with fecal incontinence underwent three-dimensional anal endosonography and magnetic resonance imaging. Images of both endoluminal techniques were evaluated for atrophy and defects of the external anal sphincter. External anal sphincter atrophy scoring with three-dimensional anal endosonography depended on the distinction of the external anal sphincter and its reflectivity. External anal sphincter atrophy scoring with magnetic resonance imaging depended on the amount of muscle and the presence of fat replacement. Atrophy score was defined as none, moderate, and severe. A defect was defined at anal endosonography by a hypoechogenic zone and at magnetic resonance imaging as a discontinuity of the sphincteric ring and/or scar tissue. Differences between three-dimensional anal endosonography and magnetic resonance imaging for the detection of external anal sphincter atrophy and defects were calculated. In addition, we compared external anal sphincter thickness and length measurements in three-dimensional anal endosonography and magnetic resonance imaging.

Results

Eighteen patients were included (median age, 58 years; range, 27–80; 15 women). Three-dimensional anal endosonography and magnetic resonance imaging did not significantly differ for the detection of external anal sphincter atrophy (P = 0.25) and defects (P = 0.38). Three-dimensional anal endosonography demonstrated atrophy in 16 patients, magnetic resonance imaging detected atrophy in 13 patients. Three-dimensional anal endosonography agreed with magnetic resonance imaging in 15 of 18 patients for the detection of external anal sphincter atrophy. Using the grading system, 8 of the 18 patients scored the same grade. Three-dimensional anal endosonography detected seven external anal sphincter defects and magnetic resonance imaging detected ten. Three-dimensional anal endosonography and magnetic resonance imaging agreed on the detection of external anal sphincter defects in 13 of 18 patients. Comparison between three-dimensional anal endosonography and magnetic resonance imaging for sphincter thickness and length measurements showed no statistically significant concordance and had no correlation with external anal sphincter atrophy.

Conclusion

This is the first study that shows that three-dimensional anal endosonography can be used for detecting external anal sphincter atrophy. Both endoanal techniques are comparable in detecting atrophy and defects of the external anal sphincter, although there is a substantial difference in grading of external anal sphincter atrophy. Correlation between three-dimensional anal endosonography and magnetic resonance imaging for thickness and length measurements is poor. Inconsistency between the two methods needs to be evaluated further.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2

Similar content being viewed by others

References

  1. SS Rao (2004) ArticleTitlePathophysiology of adult faecal incontinence Gastroenterology 126 IssueID1 Suppl 1 S14–S22 Occurrence Handle14978634

    PubMed  Google Scholar 

  2. AH Sultan MA Kamm CN Hudson (1994) ArticleTitlePudendal nerve damage during labour: prospective study before and after childbirth Br J Obstet Gynaecol 101 22–28 Occurrence Handle8297863 Occurrence Handle1:STN:280:ByuC38fmvFA%3D

    PubMed  CAS  Google Scholar 

  3. RD Madoff (2004) ArticleTitleSurgical treatment options for fecal incontinence Gastroenterology 126 IssueID1 Suppl 1 S48–S54 Occurrence Handle14978638

    PubMed  Google Scholar 

  4. T Pinta ML Kylanpaa-Back T Salmi HJ Jarvinen P Luukkonen (2003) ArticleTitleDelayed sphincter repair for obstetric ruptures: analysis of failure Colorectal Dis 5 73–78 Occurrence Handle12780931 Occurrence Handle1:STN:280:DC%2BD3s3ls1Gktw%3D%3D Occurrence Handle10.1046/j.1463-1318.2003.00408.x

    Article  PubMed  CAS  Google Scholar 

  5. EH Birnbaum L Stamm JF Rafferty RD Fry IJ Kodner JW Fleshman (1996) ArticleTitlePudendal nerve terminal motor latency influences surgical outcome in treatment of rectal prolapse Dis Colon Rectum 39 1215–1221 Occurrence Handle8918427 Occurrence Handle1:STN:280:ByiD2snhtFQ%3D Occurrence Handle10.1007/BF02055111

    Article  PubMed  CAS  Google Scholar 

  6. C Simmang EH Birnbaum IJ Kodner RD Fry JW Fleshman (1994) ArticleTitleAnal sphincter reconstruction in the elderly: does advancing age affect outcome? Dis Colon Rectum 37 1065–1069 Occurrence Handle7956570 Occurrence Handle1:STN:280:ByqD2cvmsFY%3D Occurrence Handle10.1007/BF02049804

    Article  PubMed  CAS  Google Scholar 

  7. RJ Felt-Bersma MA Cuesta M Koorevaar (1996) ArticleTitleAnal sphincter repair improves anorectal function and endosonographic image Dis Colon Rectum 39 878–885 Occurrence Handle8756843 Occurrence Handle1:STN:280:BymA38fhvVE%3D Occurrence Handle10.1007/BF02053986

    Article  PubMed  CAS  Google Scholar 

  8. AG Parks M Swash H Urich (1977) ArticleTitleSphincter denervation in anorectal incontinence and rectal prolapse Gut 18 656–665 Occurrence Handle892613 Occurrence Handle1:STN:280:CSiB2cjoslI%3D

    PubMed  CAS  Google Scholar 

  9. AF Engel MA Kamm AH Sultan CI Bartram RJ Nicholls (1994) ArticleTitleAnterior anal sphincter repair in patients with obstetric trauma Br J Surg 81 1231–1234 Occurrence Handle7953372 Occurrence Handle1:STN:280:ByqD2c7hs1M%3D

    PubMed  CAS  Google Scholar 

  10. PJ Law MA Kamm CI Bartram (1990) ArticleTitleA comparison between electromyography and anal endosonography in mapping external anal sphincter defects Dis Colon Rectum 33 370–373 Occurrence Handle2183977 Occurrence Handle1:STN:280:By%2BB38fgvFI%3D Occurrence Handle10.1007/BF02156260

    Article  PubMed  CAS  Google Scholar 

  11. RJ Felt-Bersma MA Cuesta M Koorevaar et al. (1992) ArticleTitleAnal endosonography: relationship with anal manometry and neurophysiologic tests Dis Colon Rectum 35 944–949 Occurrence Handle1395981 Occurrence Handle1:STN:280:ByyD3M%2Fhs1w%3D Occurrence Handle10.1007/BF02253496

    Article  PubMed  CAS  Google Scholar 

  12. KI Deen D Kumar JG Williams J Olliff MR Keighley (1993) ArticleTitleAnal sphincter defects. Correlation between endoanal ultrasound and surgery Ann Surg 218 201–205 Occurrence Handle8343001 Occurrence Handle1:STN:280:ByyA2czmvV0%3D

    PubMed  CAS  Google Scholar 

  13. AH Sultan MA Kamm IC Talbot RJ Nicholls CI Bartram (1994) ArticleTitleAnal endosonography for identifying external sphincter defects confirmed histologically Br J Surg 81 463–465 Occurrence Handle8173933 Occurrence Handle1:STN:280:ByuB38fivVU%3D

    PubMed  CAS  Google Scholar 

  14. JG Fletcher RF Busse SJ Riederer et al. (2003) ArticleTitleMagnetic resonance imaging of anatomic and dynamic defects of the pelvic floor in defecatory disorders Am J Gastroenterol 98 399–411 Occurrence Handle12591061 Occurrence Handle1:STN:280:DC%2BD3s%2FnvFenuw%3D%3D

    PubMed  CAS  Google Scholar 

  15. E Rociu J Stoker AW Zwamborn JS Lameris (1999) ArticleTitleEndoanal MR imaging of the anal sphincter in fecal incontinence Radiographics 19 Spec No S171–S177 Occurrence Handle10517453 Occurrence Handle1:STN:280:DyaK1MvksFSnsw%3D%3D

    PubMed  CAS  Google Scholar 

  16. NM deSouza R Puni DJ Gilderdale GM Bydder (1995) ArticleTitleMagnetic resonance imaging of the anal sphincter using an internal coil Magn Reson Q 11 45–56 Occurrence Handle7612423 Occurrence Handle1:STN:280:ByqA3snovFY%3D

    PubMed  CAS  Google Scholar 

  17. JW Briel DD Zimmerman J Stoker et al. (2000) ArticleTitleRelationship between sphincter morphology on endoanal MRI and histopathological aspects of the external anal sphincter Int J Colorectal Dis 15 87–90 Occurrence Handle10855549 Occurrence Handle1:STN:280:DC%2BD3cvntlWisA%3D%3D

    PubMed  CAS  Google Scholar 

  18. NM deSouza R Puni A Zbar DJ Gilderdale GA Coutts T Krausz (1996) ArticleTitleMR imaging of the anal sphincter in multiparous women using an endoanal coil: correlation with in vitro anatomy and appearances in fecal incontinence AJR Am J Roentgenol 167 1465–1471 Occurrence Handle8956578 Occurrence Handle1:STN:280:ByiC3MrhslM%3D

    PubMed  CAS  Google Scholar 

  19. JW Briel J Stoker E Rociu JS Lameris WC Hop WR Schouten (1999) ArticleTitleExternal anal sphincter atrophy on endoanal magnetic resonance imaging adversely affects continence after sphincteroplasty Br J Surg 86 1322–1327 Occurrence Handle10540142 Occurrence Handle1:STN:280:DC%2BD3c%2FgvF2ktg%3D%3D Occurrence Handle10.1046/j.1365-2168.1999.01244.x

    Article  PubMed  CAS  Google Scholar 

  20. E Rociu J Stoker MJ Eijkemans JS Lameris (2000) ArticleTitleNormal anal sphincter anatomy and age- and sex-related variations at high-spatial-resolution endoanal MR imaging Radiology 217 395–401 Occurrence Handle11058634 Occurrence Handle1:STN:280:DC%2BD3crhtFeqsQ%3D%3D

    PubMed  CAS  Google Scholar 

  21. AB Williams AJ Malouf CI Bartram S Halligan MA Kamm WA Kmiot (2001) ArticleTitleAssessment of external anal sphincter morphology in idiopathic fecal incontinence with endocoil magnetic resonance imaging Dig Dis Sci 46 1466–1471 Occurrence Handle11478498 Occurrence Handle1:STN:280:DC%2BD3MvjtFansg%3D%3D Occurrence Handle10.1023/A:1010639920979

    Article  PubMed  CAS  Google Scholar 

  22. AB Williams CI Bartram D Modhwadia et al. (2001) ArticleTitleEndocoil magnetic resonance imaging quantification of external anal sphincter atrophy Br J Surg 88 853–859 Occurrence Handle11412258 Occurrence Handle1:STN:280:DC%2BD3MzkvFWgtg%3D%3D Occurrence Handle10.1046/j.0007-1323.2001.01796.x

    Article  PubMed  CAS  Google Scholar 

  23. RL West RJ Felt-Bersma BE Hansen WR Schouten EJ Kuipers (2004) ArticleTitleVolume measurements of the anal sphincter complex in healthy controls and fecal-incontinent patients with a three-dimensional reconstruction of endoanal ultrasonography images Dis Colon Rectum 48 540–548

    Google Scholar 

  24. CJ Vaizey E Carapeti JA Cahill MA Kamm (1999) ArticleTitleProspective comparison of faecal incontinence grading systems Gut 44 77–80 Occurrence Handle9862829 Occurrence Handle1:STN:280:DyaK1M%2FotFKmuw%3D%3D

    PubMed  CAS  Google Scholar 

  25. MP Terra RG Beets-Tan VP Hulst Particlevan Der MG Dijkgraaf PM Bossuyt AC Dobben CG Baeten J Stoker (2005) ArticleTitleAnal sphincter defects in patients with fecal incontinence: endoanal versus external phased-array MR imaging Radiology 236 IssueID3 886–895 Occurrence Handle16014438

    PubMed  Google Scholar 

  26. Terra MP, Beets-Tan RG, van Der Hulst VP, Deutekom M, Dijkgraaf MG, Bossuyt PM, Dobben AC, Baeten CG, Stoker J. MR imaging in evaluating atrophy of the external anal sphincter in patients with fecal incontinence. AJR Am J Roentgenol, accepted.

  27. AJ Malouf S Halligan AB Williams CI Bartram S Dhillon M Kamm (2001) ArticleTitleProspective assessment of interobserver agreement for endoanal MRI in fecal incontinence Abdom Imaging 26 76–78 Occurrence Handle11116366 Occurrence Handle1:STN:280:DC%2BD3MzitFehtA%3D%3D Occurrence Handle10.1007/s002610000100

    Article  PubMed  CAS  Google Scholar 

  28. AC Poen RJ Felt–Bersma W Deville MA Cuesta SG Meuwissen (1997) ArticleTitleSphincter measurements in anal endosonography: normal values and reproducibility Eur J Ultrasound 6 103–110 Occurrence Handle10.1016/S0929-8266(97)10001-5

    Article  Google Scholar 

  29. DM Gold S Halligan WA Kmiot CI Bartram (1999) ArticleTitleIntraobserver and interobserver agreement in anal endosonography Br J Surg 86 371–375 Occurrence Handle10201781 Occurrence Handle1:STN:280:DyaK1M3hsF2ltg%3D%3D

    PubMed  CAS  Google Scholar 

  30. AG Parks (1975) ArticleTitleAnorectal incontinence Proc R Soc Med 68 681–690 Occurrence Handle1197295 Occurrence Handle1:STN:280:CSmD2sfltlc%3D

    PubMed  CAS  Google Scholar 

  31. MR Keighley JW Fielding (1983) ArticleTitleManagement of faecal incontinence and results of surgical treatment Br J Surg 70 463–468 Occurrence Handle6871636 Occurrence Handle1:STN:280:BiyB2Mfis1E%3D

    PubMed  CAS  Google Scholar 

  32. DT Fang S Nivatvongs FD Vermeulen FN Herman SM Goldberg DA Rothenberger (1984) ArticleTitleOverlapping sphincteroplasty for acquired anal incontinence Dis Colon Rectum 27 720–722 Occurrence Handle6389047 Occurrence Handle1:STN:280:BiqD2M%2FmsFM%3D

    PubMed  CAS  Google Scholar 

  33. GG Browning AG Parks (1983) ArticleTitlePost-anal repair for neuropathic faecal incontinence: correlation of clinical results and anal canal pressures? Br J Surg 70 101–104 Occurrence Handle6824891 Occurrence Handle1:STN:280:BiyC38fitVA%3D

    PubMed  CAS  Google Scholar 

  34. RW Motson (1985) ArticleTitleSphincter injuries: indications for, and results of sphincter repair Br J Surg 72 IssueIDSuppl S19–S21 Occurrence Handle4041754

    PubMed  Google Scholar 

  35. S Gearhart T Hull C Floruta T Schroeder J Hammel (2005) ArticleTitleAnal manometric parameters: predictors of outcome following anal sphincter repair? J Gastrointest Surg 9 115–120 Occurrence Handle15623452 Occurrence Handle10.1016/j.gassur.2004.04.001

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, VU Medical Center, Amsterdam, The Netherlands

    Marcel Cazemier M.D., Chris J. J. Mulder M.D., Ph.D. & Richelle J. F. Felt–Bersma M.D., Ph.D.

  2. Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands

    Maaike P. Terra M.D. & Jaap Stoker M.D., Ph.D.

  3. Department of Clinical Epidemiology & Biostatistics, VU Medical Center, Amsterdam, The Netherlands

    Elly S. M. de Lange-de Klerk M.D., Ph.D.

  4. Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands

    Guy E. E. Boeckxstaens M.D., Ph.D.

  5. VU Medical Center, De Boelelaan 1117, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands

    Marcel Cazemier M.D.

Authors
  1. Marcel Cazemier M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maaike P. Terra M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jaap Stoker M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elly S. M. de Lange-de Klerk M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Guy E. E. Boeckxstaens M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Chris J. J. Mulder M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Richelle J. F. Felt–Bersma M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marcel Cazemier M.D..

Additional information

Supported in part by grant No. 945-01-013 from the Netherlands Organization for Health Research and Development.

Reprints are not available.

About this article

Cite this article

Cazemier, M., Terra, M.P., Stoker, J. et al. Atrophy and Defects Detection of the External Anal Sphincter: Comparison Between Three-Dimensional Anal Endosonography and Endoanal Magnetic Resonance Imaging. Dis Colon Rectum 49, 20–27 (2006). https://doi.org/10.1007/s10350-005-0220-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10350-005-0220-8

Key words

Search

Navigation