Endoanal MR imaging of the anal sphincter in fecal incontinence
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Published on: October 17, 2013
E Rociu1, J Stoker, A W Zwamborn
1Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Abstract:
Fecal incontinence is a major medical and social problem. The most frequent cause is a pathologic condition of the anal sphincter. Endoanal magnetic resonance (MR) imaging allows detailed visualization of the normal anatomy and pathologic conditions of the anal sphincter. The hyperintense internal sphincter appears as a continuation of the smooth muscle of the rectum; the hypointense external sphincter surrounds the lower part of the internal sphincter. A sphincteric defect is seen as a discontinuity of the muscle ring. Scarring appears as a hypointense deformation of the normal pattern of the muscle layer. Two external sphincteric patterns may be misdiagnosed as defects: a posterior discontinuity (often seen in young male patients) and an anterior discontinuity (often seen in female patients). Atrophy of the external sphincter is easily detected on coronal MR images by comparing the thicknesses of all anal muscles. Endoanal MR imaging is superior to endoanal ultrasonography because of the multiplanar capability and higher inherent contrast resolution of the former. Use of endoanal MR imaging may lead to better selection of candidates for surgery and therefore better surgical results. Endoanal MR imaging is the most accurate technique for detection and characterization of sphincteric lesions and planning of optimal therapy.
Insights
Endoanal magnetic resonance (MR) imaging precisely detects anal sphincter defects causing fecal incontinence. This advanced imaging technique improves surgical candidate selection and leads to better patient outcomes.
Area of Science:
- Radiology
- Gastroenterology
- Pelvic Floor Disorders
Background:
- Fecal incontinence is a significant medical and social issue.
- Anal sphincter pathology is the most common cause.
- Accurate diagnosis is crucial for effective treatment.
Purpose of the Study:
- To evaluate the utility of endoanal magnetic resonance (MR) imaging.
- To assess its accuracy in detecting and characterizing anal sphincter defects.
- To compare its efficacy against endoanal ultrasonography.
Main Methods:
- Utilized endoanal MR imaging to visualize anal sphincter anatomy.
- Identified characteristic MR signal intensities and patterns for internal and external sphincters.
- Analyzed MR images for discontinuities, scarring, and atrophy indicating sphincter defects.
Main Results:
- Endoanal MR imaging provides detailed visualization of anal sphincter anatomy and pathology.
- Sphincteric defects appear as muscle ring discontinuities or scarring.
- Distinguished true defects from normal variations like posterior or anterior discontinuities.
- Coronal MR images effectively detect external sphincter atrophy.
Conclusions:
- Endoanal MR imaging is superior to ultrasonography due to multiplanar imaging and higher contrast resolution.
- It is the most accurate technique for identifying and characterizing sphincteric lesions.
- Improved diagnostic accuracy can lead to better surgical candidate selection and outcomes.
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