大便失禁患者的磁共振排粪造影：影像学表现及其对手术治疗的影响

MR defecography in patients with fecal incontinence: imaging findings and their effect on surgical management.

作者信息

Hetzer Franc H, Andreisek Gustav, Tsagari Christina, Sahrbacher Ulli, Weishaupt Dominik

机构信息

Division of Visceral and Transplantation Surgery, University Hospital, Raemistrasse 100, 8091 Zurich, Switzerland.

出版信息

Radiology. 2006 Aug;240(2):449-57. doi: 10.1148/radiol.2401050648. Epub 2006 Jun 26.

DOI:10.1148/radiol.2401050648

PMID:16801366

Abstract

PURPOSE

To retrospectively evaluate magnetic resonance (MR) defecography findings in patients with fecal incontinence who were evaluated for surgical treatment and to assess the influence of MR defecography on surgical therapy.

MATERIALS AND METHODS

Institutional review board approval was obtained. Informed consent was waived; however, written informed consent for imaging was obtained. Fifty patients (44 women, six men; mean age, 61 years) with fecal incontinence were placed in a sitting position and underwent MR defecography performed with an open-configuration MR system. Midsagittal T1-weighted MR images were obtained at rest, at maximal contraction of the sphincter, and at defecation. Images were prospectively and retrospectively reviewed by two independent observers for a variety of findings. Interobserver agreement was analyzed by calculating kappa statistics. Prospective interpretation of MR defecography findings was used to influence surgical therapy, and retrospective interpretation was used for concomitant pelvic floor disorders.

RESULTS

MR defecography revealed rectal descent of more than 6 cm (relative to the pubococcygeal line) in 47 (94%) of 50 patients. A bladder descent of more than 3 cm was present in 20 (40%) of 50 patients, and a vaginal vault descent of more than 3 cm was present in 19 (43%) of 44 women. Moreover, 17 (34%) anterior proctoceles, 16 (32%) enteroceles, and 10 (20%) rectal prolapses were noted. Interobserver agreement was good to excellent (kappa = 0.6-0.91) for image analysis results. MR defecography findings led to changes in the surgical approach in 22 (67%) of 33 patients who underwent surgery.

CONCLUSION

MR defecography may demonstrate a variety of abnormal findings in patients who are considered candidates for surgical therapy for fecal incontinence, and the findings may influence the surgical treatment that is subsequently chosen.

SUPPLEMENTAL MATERIAL

http://radiology.rsnajnls.org/cgi/content/full/2402050648/DC1

摘要

目的

回顾性评估接受手术治疗评估的大便失禁患者的磁共振排粪造影结果，并评估磁共振排粪造影对手术治疗的影响。

材料与方法

获得机构审查委员会批准。无需知情同意书；然而，获得了关于成像的书面知情同意书。50例大便失禁患者（44例女性，6例男性；平均年龄61岁）采用坐姿，使用开放式磁共振系统进行磁共振排粪造影。在静息、括约肌最大收缩和排便时获取矢状面T1加权磁共振图像。两名独立观察者对图像进行前瞻性和回顾性评估，以发现各种情况。通过计算kappa统计量分析观察者间的一致性。磁共振排粪造影结果的前瞻性解读用于影响手术治疗，回顾性解读用于评估伴发的盆底疾病。

结果

50例患者中有47例（94%）磁共振排粪造影显示直肠下降超过6cm（相对于耻骨尾骨线）。50例患者中有20例（40%）膀胱下降超过3cm，44例女性中有19例（43%）阴道穹窿下降超过3cm。此外，发现17例（34%）前直肠膨出、16例（32%）小肠膨出和10例（20%）直肠脱垂。图像分析结果的观察者间一致性良好至优秀（kappa=0.6-0.91）。33例接受手术的患者中有22例（67%）的磁共振排粪造影结果导致手术方式改变。