Test order, timing, and multidisciplinary review predict management change in sequential fluoroscopic and MR...

To determine whether sequential fluoroscopic defecography (FLD) and MR defecography (MRD) change clinical management of patients with pelvic floor dysfunction and to identify factors associated with management change.

Multi-institutional retrospective study including adults who underwent both FL and MR defecography within 3 years, without interval surgery. Primary outcome was management change attributed to the second examination. Clinical information, test order & timing, multidisciplinary review, and imaging variables were compared between patients with and without management change. Univariate analyses were performed overall and by first-modality subgroup. Multivariable logistic regression was performed in the overall cohort.

Of 46 patients, 24 underwent FLD first and 22 underwent MRD first. Management changed after second examination in 23.9% (11/46). FLD-first order (adjusted OR, 72.70; 95% CI, 2.77-1909.81; p = 0.010), shorter interval between examinations (adjusted OR per 30 days, 0.74; 95% CI, 0.68-1.00; p = 0.038), and wider MR resting anorectal angle (adjusted OR per degree, 1.10; 95% CI, 1.02-1.20; p = 0.016) were independent predictors of management change. MRD after FLD showed more frequent new second-test abnormalities than FLD after MRD (16/24 [66.7%] vs. 5/22 [22.7%], p = 0.0037), particularly new cystocele detection (41.7% vs. 0%, p = 0.0006). In the FLD-first subgroup, multidisciplinary review was associated with management change (5/5 [100%] vs. 5/19 [26.3%], p = 0.0059).

Sequential multimodality defecography changed management in approximately one-quarter of patients. Its value was greatest when MRD followed FLD, especially when examinations were performed closely together. MRD after FLD detected a higher frequency of second-test abnormalities, particularly cystocele. The association between multidisciplinary review and management change suggests that the clinical impact of sequential defecography depends not only on the added imaging findings but also on how they are integrated into treatment planning.