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Spine evaluation in children with anorectal malformations
F J Beek1, T M Boemers, F J Beek
1Department of Radiology, University Children's Hospital, Nieuwegracht 137, 3512 LK Utrecht, The Netherlands.
Insights
Radiography and ultrasound effectively detect skeletal and intraspinal abnormalities in infants with anorectal malformations. Magnetic resonance imaging (MRI) is recommended only when initial imaging reveals potential issues.
Area of Science:
- Pediatric Radiology
- Medical Imaging
- Congenital Abnormalities
Background:
- Anorectal malformations (ARMs) are associated with a high incidence of spinal abnormalities.
- Early detection of skeletal and intraspinal pathology is crucial for managing infants with ARMs.
- The comparative diagnostic value of radiography, ultrasound, and MRI for spinal assessment in this population requires clarification.
Purpose of the Study:
- To evaluate the efficacy of radiography, ultrasound, and magnetic resonance imaging (MRI) in identifying skeletal and intraspinal pathologies in infants with ARMs.
- To determine the necessity of spinal MRI for infants diagnosed with anorectal malformations.
Main Methods:
- Retrospective analysis of 21 infants with anorectal malformations.
- All infants underwent lower spine examination using radiography, ultrasound, and MRI.
- Comparative assessment of the detection rates for skeletal and intraspinal abnormalities across the three imaging modalities.
Main Results:
- Radiography identified subtle bony skeletal abnormalities in 6 out of 21 patients.
- Ultrasound detected both bony and cartilaginous malformations in all 6 affected patients; MRI identified them in 5.
- Intraspinal pathology was present in 5 of the 6 patients with skeletal abnormalities, detected by both ultrasound and MRI, with MRI providing clearer visualization.
Conclusions:
- Careful examination of spinal radiographs is essential as they can indicate potential intraspinal pathology.
- Normal findings on radiography and ultrasound may render MRI unnecessary for spinal assessment in infants with ARMs.
- MRI is valuable for accurately depicting intraspinal pathology when radiography or ultrasound results are abnormal.
Abstract:
The value of radiography, ultrasound and magnetic resonance imaging (MRI) in detecting skeletal and intraspinal pathology was assessed in infants with anorectal malformations, and the need for spinal MRI examination in this group of patients was evaluated. Twenty-one infants were examined with radiography, ultrasound and MRI of the lower spine. The detection of skeletal and intraspinal abnormalities was compared for the three imaging modalities. Fifteen patients were normal in all three examinations. Radiography showed bony skeletal abnormalities in six children, although sometimes very subtle. By ultrasound both bony and cartilaginous malformations were detected in all six patients and by MRI in five patients. Five of the six children with skeletal abnormalities had intraspinal pathology, detected in all cases by ultrasound and MRI. However, the abnormalities were more clearly demonstrated by MRI than by ultrasound. Spinal radiographs must be examined carefully for abnormalities, because they can indicate the presence or absence of intraspinal pathology. Normal radiographic and sonographic appearance of spinal anatomy in children with anorectal malformation makes MRI superfluous, but if radiographs or ultrasound are abnormal, MRI should be used to accurately depict possible intraspinal pathology.