Beer-Gabel Marc, Carter Dan
Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Israel,
Int J Colorectal Dis. 2015 Jun;30(6):835-41. doi: 10.1007/s00384-015-2195-9. Epub 2015 Mar 31.
X-ray defecography is considered the gold standard for imaging pelvic floor pathology. However, it is limited by the capability to demonstrate only the posterior pelvic compartment, significant radiation exposure, and inconvenience. Dynamic transperineal ultrasound (DTP-US) can visualize all of three pelvic floor compartments, is free of radiation, and does not cause significant discomfort. The aim of this study was to evaluate the level of consistency between defecography (DEF) and DTP-US in the diagnosis of pelvic floor deformations.
One hundred and five women (age 56 ± 11 years) suffering from constipation and fecal incontinence were clinically evaluated and further examined by DEF and DTP-US. The rate of diagnosis of pelvic floor hernias using the DTP-US was compared to that found on DEF.
The specificity for the diagnosis of rectoceles was of 82% for mid-size rectocele and 98% for large rectoceles, and the sensitivity was of 59% for mid-size rectoceles and 50% for larger rectoceles. The sensitivity for the detection of intussusceptions, enteroceles, and rectal prolapse were 82, 74, and 75%, respectively. The specificity was 84% for the detection of intussusception, 92% for enteroceles, and 97% for the diagnosis of rectal prolapse. Higher rates of DTP-US diagnosis were obtained when the intussuscepted rectum moved closer toward the ultrasound probe.
The sensitivity of DTP-US was good to excellent and the specificity was high. The added value of this technique in exploring all the compartments of the pelvic floor as well as the perineal muscles makes DTP-US a preferred procedure.
X线排粪造影被认为是盆底病理学成像的金标准。然而，它仅能显示盆腔后间隙，存在辐射暴露量大以及操作不便等局限性。动态经会阴超声（DTP-US）可以可视化所有三个盆底间隙，无辐射且不会引起明显不适。本研究的目的是评估排粪造影（DEF）和DTP-US在诊断盆底畸形方面的一致性水平。
对105名患有便秘和大便失禁的女性（年龄56±11岁）进行临床评估，并进一步通过DEF和DTP-US检查。将使用DTP-US诊断盆底疝的比率与DEF检查结果进行比较。
诊断中度直肠膨出的特异性为82%，重度直肠膨出为98%；中度直肠膨出的敏感性为59%，重度直肠膨出为50%。套叠、肠膨出和直肠脱垂的检测敏感性分别为82%、74%和75%。套叠检测的特异性为84%，肠膨出为92%，直肠脱垂诊断为97%。当套叠的直肠向超声探头移动更近时，DTP-US诊断率更高。
DTP-US的敏感性良好至优秀，特异性高。该技术在探查盆底所有间隙以及会阴肌肉方面的附加价值使得DTP-US成为首选检查方法。
