Bhan Sasha N, Mnatzakanian Gevork N, Nisenbaum Rosane, Lee Allan B, Colak Errol
Department of Medical Imaging, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
Abdom Radiol (NY). 2016 Feb;41(2):215-20. doi: 10.1007/s00261-015-0577-7.
The purpose of the study was to determine if the strain phase of an MR defecography (MRD) protocol is redundant and can be eliminated without a loss of diagnostic information.
Institutional review board approval was obtained and the requirement for informed consent was waived. A retrospective single-center review of 80 MRD examinations (68 female, 12 male, mean age 55 years old) was conducted. Two radiologists blinded to patient information evaluated in consensus the strain and evacuation phases separately and in a random order. Each phase was assessed for the presence and degree of posterior compartment descent, cystocele, urethral hypermobility, uterovaginal prolapse, rectocele, rectal intussusception, and enterocele. The degree of pelvic floor descent was compared using a paired t test and McNemar's test was used to compare the proportion of abnormal findings.
The evacuation phase identified all abnormalities identified on the strain phase and also identified both additional and more pronounced abnormalities, including an additional 34 cystoceles, 20 cases of urethral hypermobility, 13 uterovaginal prolapses, 36 rectoceles, 5 rectal intussusceptions, and 6 enteroceles (all p < 0.02). The mean posterior compartment descent was 24.1 mm greater on the evacuation phase than the strain phase (p < 0.0001).
The strain phase is redundant and we propose that it can be eliminated from a routine MRD protocol. This will help streamline the examination, simplify patient instructions, and reduce both imaging and reporting time.
本研究的目的是确定磁共振排粪造影（MRD）检查中用力相是否多余，以及能否在不损失诊断信息的情况下将其去除。
获得了机构审查委员会的批准，并免除了知情同意的要求。对80例MRD检查（68例女性，12例男性，平均年龄55岁）进行了回顾性单中心研究。两名对患者信息不知情的放射科医生以随机顺序分别对用力相和排空相进行了一致性评估。对每个阶段评估后盆腔下降、膀胱膨出、尿道活动过度、子宫阴道脱垂、直肠膨出、直肠套叠和小肠膨出的存在情况及程度。使用配对t检验比较盆底下降程度，使用McNemar检验比较异常发现的比例。
排空相识别出了用力相中发现的所有异常，还发现了更多额外的和更明显的异常，包括另外34例膀胱膨出、20例尿道活动过度、13例子宫阴道脱垂、36例直肠膨出、5例直肠套叠和6例小肠膨出（所有p<0.02）。排空相的后盆腔平均下降比用力相大24.1mm（p<0.0001）。
用力相是多余的，我们建议可以从常规MRD检查方案中去除。这将有助于简化检查流程，简化患者指导，并减少成像和报告时间。
