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Pre-operative MRI of anorectal anomalies in the newborn period
1Department of Radiology, John Radcliffe Hospital, Headington, Oxford OX 3 9 DU, UK.
Insights
Magnetic resonance imaging (MRI) accurately assesses anorectal anomalies in newborns before surgery. MRI aids in surgical planning and predicting continence, though clinical examination remains crucial.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Neonatology
Background:
- Anorectal malformations (ARMs) are congenital anomalies requiring prompt diagnosis and surgical intervention.
- Accurate pre-operative assessment is vital for surgical planning and predicting functional outcomes in neonates with ARMs.
Purpose of the Study:
- To evaluate the utility of Magnetic Resonance Imaging (MRI) in characterizing anorectal anomalies in newborns prior to surgical correction.
- To assess the concordance between MRI findings and surgical outcomes.
- To determine MRI's role in identifying associated genitourinary and spinal anomalies.
Main Methods:
- Prospective study involving nine neonates with anorectal anomalies.
- Pre-operative MRI examinations were performed to assess the level and type of anomaly, and associated abnormalities.
- Comparison of MRI findings with surgical findings and clinical examinations.
Main Results:
- MRI correctly identified the level of anorectal anomaly in 8 out of 9 infants; one low anomaly was revised to high at surgery.
- Associated anomalies included hydronephrosis (n=2), renal agenesis (n=1), sacrococcygeal hypoplasia (n=2), and hemivertebrae (n=1).
- MRI visualized puborectal and external anal sphincter muscles, aiding in surgical guidance and continence prediction. Hyperintense T1 signal meconium facilitated rectal differentiation.
Conclusions:
- MRI is a valuable tool for pre-operative assessment of anorectal anomalies in neonates, providing detailed anatomical information.
- MRI findings correlate well with surgical outcomes, aiding in surgical planning and predicting functional continence.
- While MRI is highly informative, thorough clinical examination remains essential, especially in cases with unexpected clinical presentations like meconium per urethram.
Abstract:
Nine infants (six boys, three girls) with anorectal anomalies were examined in the immediate newborn period, prior to corrective surgery, with MRI. Three high, one intermediate and five low anomalies were found at MRI - one patient with a low lesion was subsequently found at surgery 2 months later to have a high anorectal anomaly. This infant had passed meconium per urethram soon after the MRI study, prompting the need for a protective colostomy and stressing the importance of a thorough clinical examination of babies with anorectal malformations. The MRI results and findings at surgery were in agreement in all other patients (n = 8). Hydronephrosis was evident in two and renal agenesis in one patient. Sacrococcygeal hypoplasia was found in two and two hemivertebrae in one infant. No spinal cord lesion was identified. One fistula was evident on MRI but four were later found at surgery. Uniformly hyperintense T 1 signal meconium was seen in all nine newborns, allowing for easy differentiation of rectal contents from rectal wall and the adjacent musculature. MRI can provide useful information regarding the development of the puborectal and external anal sphincter muscles, can help guide the pull-through procedure and help predict future continence pre-operatively in the newborn period.