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Sacral development in anorectal malformations and in normal population.

M Torre1, G Martucciello, V Jasonni

  • 1Department of Paediatric Surgery, G. Gaslini Institute, Largo G. Gaslini, 5, 16 147 Genoa, Italy. micheletorre@hotmail.com

Pediatric Radiology
|December 1, 2001
PubMed
Summary

The sacral ratio (SR) is a valuable tool for assessing anorectal malformations (ARM). Values below 0.52 indicate potential spinal cord issues and poor prognosis in children with ARM.

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Area of Science:

  • Pediatric Surgery
  • Radiology
  • Developmental Biology

Background:

  • The sacral ratio (SR) was introduced in 1995 to assess sacral development in anorectal malformations (ARM).
  • Previous studies established average normal SR values of 0.74 for anteroposterior (APSR) and 0.77 for lateral (LSR) views.

Purpose of the Study:

  • To determine the normal range of SR variability in children and its correlation with age.
  • To assess the SR's reliability as a prognostic indicator for ARM patients.

Main Methods:

  • Pelvic radiographs of 147 normal children were analyzed to establish normal SR ranges.
  • In 59 ARM patients, SR values were correlated with continence, spinal cord anomalies (MRI), and rectal innervation (enzymo-histochemistry).
  • SR was measured longitudinally in 25 children (15 with ARM, 10 controls).

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Main Results:

  • Normal APSR ranged from 0.52 to 1.12 (average 0.74), and LSR from 0.52 to 1.18 (average 0.75).
  • SR values below 0.52 strongly correlated with spinal cord anomalies and poor functional outcomes in ARM.
  • SR increased with age in normal children but decreased in ARM patients.

Conclusions:

  • The sacral ratio exhibits a broad normal range; values below 0.52 are considered pathological.
  • Age significantly influences SR values, with distinct patterns in normal development versus ARM.
  • A low sacral ratio is a significant indicator of adverse prognosis in pediatric anorectal malformations.