Putz Cornelia, Alt Celine D, Hensel Cornelia, Wagner Björn, Gantz Simone, Gerner Hans-Jürgen, Weidner Norbert, Grenacher Lars
Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
Eur J Radiol. 2017 Jun;91:15-21. doi: 10.1016/j.ejrad.2017.02.036. Epub 2017 Mar 21.
To investigate whether MR-defecography can be employed in sensorimotor complete spinal cord injury (SCI) subjects as a potential diagnostic tool to detect defecational disorders associated with neurogenic bowel dysfunction (NBD) using standard parameters for obstructed defecation.
In a prospective single centre clinical trial, we developed MR-defecography in traumatic sensorimotor complete paraplegic SCI patients with upper motoneuron type injury (neurological level of injury T1 to T10) using a conventional 3T scanner. Defecation was successfully induced by eliciting the defecational reflex after rectal filling with ultrasonic gel, application of two lecicarbon suppositories and digital rectal stimulation. Examination was performed with patients in left lateral decubitus position using T2-weighted turbo spin echo sequence in the sagittal plane at rest (TE 89ms, TR 3220ms, FOV 300mm, matrix 512×512, ST 4mm) and ultrafast-T2-weighted-sequence in the sagittal plane with repeating measurements (TE 1.54ms, TR 3.51ms, FOV 400mm, matrix 256×256, ST 6mm). Changes of anorectal angle (ARA), anorectal descent (ARJ) and pelvic floor weakness were documented and measured data was compared to reference values of asymptomatic non-SCI subjects in the literature to assess feasibility.
MR-defecography provides evaluable imaging sequences of the induced evacuation phase in SCI patients. Measurement results for ARA, ARJ, hiatal width (H-line) and hiatal descent (M-line) deviate significantly from reference values in the literature in asymptomatic subjects without SCI. The overall mean values in our study for SCI patients were: ARA (rest) 127.3°, ARA (evacuation) 137.6°, ARJ (rest) 2.4cm, ARJ (evacuation) 4.0cm, H-line (rest) 7.6cm, H-line (evacuation) 8.1cm, M-line (rest) 2.6cm, M-line (evacuation) 4.2cm.
MR-defecography is feasible in sensorimotor complete SCI patients. Individual MR-defecography findings may help to determine specific therapeutical options for respective patients suffering from severe NBD.
探讨磁共振排粪造影是否可用于感觉运动完全性脊髓损伤（SCI）患者，作为一种潜在的诊断工具，使用排便梗阻的标准参数来检测与神经源性肠功能障碍（NBD）相关的排便障碍。
在一项前瞻性单中心临床试验中，我们使用传统的3T扫描仪，对创伤性感觉运动完全性截瘫的上运动神经元型损伤（损伤神经平面为T1至T10）的SCI患者进行磁共振排粪造影。在直肠注入超声凝胶、使用两粒双醋苯啶栓剂并进行直肠指诊刺激以引发排便反射后，成功诱导排便。检查时患者取左侧卧位，在矢状面使用T2加权快速自旋回波序列进行静息扫描（回波时间89毫秒，重复时间3220毫秒，视野300毫米，矩阵512×512，层厚4毫米），并在矢状面使用超快T2加权序列进行重复测量（回波时间1.54毫秒，重复时间3.51毫秒，视野400毫米，矩阵256×256，层厚6毫米）。记录肛管直肠角（ARA）、肛管直肠下移（ARJ）和盆底肌薄弱情况的变化，并将测量数据与文献中无症状非SCI受试者的参考值进行比较，以评估其可行性。
磁共振排粪造影可为SCI患者诱导排便期提供可评估的成像序列。ARA、ARJ、裂孔宽度（H线）和裂孔下移（M线）的测量结果与文献中无症状非SCI受试者的参考值有显著差异。我们研究中SCI患者的总体平均值为：ARA（静息）127.3°，ARA（排便）137.6°，ARJ（静息）2.4厘米，ARJ（排便）4.0厘米，H线（静息）7.6厘米，H线（排便）8.1厘米，M线（静息）2.6厘米，M线（排便）4.2厘米。
磁共振排粪造影在感觉运动完全性SCI患者中是可行的。个体磁共振排粪造影结果可能有助于为患有严重NBD的患者确定具体的治疗方案。
