Division of Pediatric Urology, Department of Pediatric Surgery, Ege University, 35100, Izmir, Turkey.
Department of Pediatric Surgery, Ege University, Izmir, Turkey.
Pediatr Surg Int. 2022 Apr;38(4):609-616. doi: 10.1007/s00383-022-05077-3. Epub 2022 Feb 7.
Neurogenic bladder with anorectal malformations (ARM) is a well-known yet understudied topic. Diffusion tensor imaging (DTI) is a special usage of MRI that can evaluate peripheric nerves. The aim of this study is to evaluate the lumbosacral plexuses of patients with ARM using DTI.
Patients with ARM willing to participate were included. Patient files were reviewed, a questionnaire was made, and DTI was performed. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were computed for the right and left lumbosacral plexuses.
There were 18 patients and 12 controls. Groups were similar in terms of sex (p = 0.232) and age (p = 0.853). There was a significant difference only for ADC of the left plexus. There was visible asymmetry in tractographies and DTI parameters of two patients with severely deformed pelvises (image 1) but also in another patient with a normal sacrum. In addition, despite asymmetry, FA and ADC were similar to controls also in these patients.
This is the first study presenting quantitative data about the lumbosacral plexus in ARM. We think the most interesting finding of this study was observing the normal values even in the patients with severely malformed sacrum which is yet to be validated with further studies.
伴有肛门直肠畸形（ARM）的神经性膀胱是一个广为人知但研究不足的课题。弥散张量成像（DTI）是 MRI 的一种特殊应用，可以评估周围神经。本研究旨在使用 DTI 评估 ARM 患者的腰骶丛。
纳入愿意参与的 ARM 患者。查阅患者病历，制作问卷，并进行 DTI。计算右侧和左侧腰骶丛的各向异性分数（FA）和表观扩散系数（ADC）。
共纳入 18 例患者和 12 例对照。两组在性别（p=0.232）和年龄（p=0.853）方面相似。仅左侧丛的 ADC 有显著差异。两名骨盆严重畸形患者（图 1）的轨迹和 DTI 参数存在明显不对称，但另一名骶骨正常的患者也存在不对称。此外，尽管存在不对称，但这些患者的 FA 和 ADC 与对照组相似。
这是第一项关于 ARM 腰骶丛的定量数据研究。我们认为，本研究最有趣的发现是观察到即使在骶骨严重畸形的患者中也存在正常值，这有待进一步研究证实。
