Diffusion tensor imaging in anorectal malformations: a pilot study for the evaluation of lumbosacral plexus

Area of Science:

• Neuroimaging
• Neurology
• Pediatric Surgery

Background:

• Neurogenic bladder associated with anorectal malformations (ARM) is a recognized clinical issue.
• Diffusion tensor imaging (DTI), a specialized MRI technique, offers a method to assess peripheral nerve integrity.
• The lumbosacral plexus is crucial for anorectal and bladder function, making its evaluation in ARM patients important.

Purpose of the Study:

• To quantitatively evaluate the lumbosacral plexuses in patients diagnosed with anorectal malformations (ARM) using DTI.
• To investigate potential correlations between DTI parameters and the severity of pelvic or sacral malformations in ARM patients.
• To establish baseline DTI metrics for the lumbosacral plexus in this patient population.

Main Methods:

• Inclusion of patients with ARM who consented to participate.
• Comprehensive review of patient medical records and administration of a structured questionnaire.
• Performance of Diffusion Tensor Imaging (DTI) to acquire data on the lumbosacral plexuses.
• Calculation of Fractional Anisotropy (FA) and Apparent Diffusion Coefficient (ADC) for both right and left lumbosacral plexuses.

Main Results:

• The study included 18 patients with ARM and 12 healthy controls, with no significant differences in sex or age distribution between groups.
• A statistically significant difference was observed solely in the apparent diffusion coefficient (ADC) of the left lumbosacral plexus.
• Despite visible asymmetry in tractography and DTI parameters in some patients, especially those with severe pelvic deformities, overall FA and ADC values remained comparable to control groups.

Conclusions:

• This research presents the first quantitative DTI data specifically characterizing the lumbosacral plexus in individuals with ARM.
• The study highlights the surprising finding of largely normal DTI parameters in the lumbosacral plexus, even in patients with significant sacral malformations.
• Further research is warranted to validate these initial findings and explore their clinical implications for neurogenic bladder and anorectal function in ARM patients.