The advantages of volume rendering in three-dimensional endosonography of the anorectum

Anorectal diseases require imaging for proper case management. At present, endoanal ultrasonography and endorectal ultrasonography have become important parts of diagnostic workup of patients with fecal incontinence, perianal fistulas, and rectal cancer and provides sufficient information for clinical decision-making in many cases. However, with the currently available ultrasonographic equipment and techniques, a good deal of relevant information may remain hidden. The advent of high-resolution three-dimensional endoluminal ultrasound, constructed from a synthesis of standard two-dimensional cross-sectional images, and of "Volume Render Mode," a technique to analyze information inside a three-dimensional volume by digitally enhancing individual voxels, promises to revolutionize diagnosis of pelvic floor disorders. By use of the different postprocessing display parameters, the volume-rendered image provides better visualization performance when there are not large differences in the signal levels of pathologic structures compared with surrounding tissues. The anatomic structures in the pelvis, the axial and longitudinal extension of anal sphincter defects, the anatomy of the fistulous tract in complex perianal sepsis, and the presence of slight or massive submucosal invasion in early rectal cancer may be imaged in greater detail. This additional information will bring an improvement for both planning and conduct of surgical procedures.