Urogynaecology and Pelvic Floor Reconstruction Unit, Croydon University Hospital, Croydon, UK.
St George's University of London, London, UK.
Ultrasound Obstet Gynecol. 2022 Dec;60(6):793-799. doi: 10.1002/uog.24957. Epub 2022 Nov 10.
To evaluate the agreement between three-dimensional endoanal ultrasound (EAUS) and four-dimensional transperineal ultrasound (TPUS) in measuring anal sphincter defect angle.
This was a secondary analysis of the PERINEAL study, which evaluated the effect of perineal wound infection on anal sphincter integrity. Women were reviewed once a week, until their perineal wound had healed or for up to a maximum of 16 weeks. At each visit, both EAUS and TPUS (the latter at rest and on maximum pelvic floor muscle contraction (PFMC)) were performed to evaluate the presence of external (EAS) and internal (IAS) anal sphincter defect and measure the defect size. The largest angle size of a defect at the same sphincter level was analyzed. A defect was deemed significant if it was > 30°. Kappa coefficient (κ), intraclass correlation coefficient and standard error of measurement (SEM) were calculated, using EAUS as the reference standard.
In 73 women scanned at weekly intervals, a total of 250 EAUS and 250 TPUS scans were performed. An EAS defect was found in 55 (22.0%) EAUS images and 47 (18.8%) TPUS images. An IAS defect was found in 26 (10.4%) images on both modalities. There was excellent agreement (κ = 0.87) between TPUS and EAUS in diagnosing the presence of an EAS defect and perfect agreement (κ = 1.00) in diagnosing the presence of an IAS defect. TPUS performed at rest had poor and moderate agreement with EAUS in measuring EAS and IAS defect size, respectively, with respective SEMs of ± 16.1° and ± 27.9°. TPUS performed during maximum PFMC had poor and moderate agreement with EAUS in measuring EAS and IAS defect size, respectively, with respective SEMs of ± 16.5° and ± 26.4°. Based on the SEMs, if the diagnostic cut-off of 30° for defect size on TPUS was used, an incorrect diagnosis of significant EAS defect could occur in approximately 9-36% of women and an incorrect diagnosis of a significant IAS defect could occur in approximately 4-15% of women, using EAUS as the reference.
This is the first study to compare directly anal sphincter defect angle measurements obtained on EAUS and TPUS. A cut-off angle of 30° should not be used for the diagnosis of a significant residual anal sphincter defect during TPUS examination. Further research is required to determine the optimal defect cut-off angle for TPUS. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
评估三维经肛门超声（EAUS）和四维经会阴超声（TPUS）在测量肛门括约肌缺陷角度方面的一致性。
这是 PERINEAL 研究的二次分析，该研究评估了会阴伤口感染对肛门括约肌完整性的影响。每周对女性进行一次检查，直到她们的会阴伤口愈合，或最长 16 周。每次就诊时，均进行 EAUS 和 TPUS（后者在休息时和最大盆底肌肉收缩（PFMC）时）检查，以评估外部（EAS）和内部（IAS）肛门括约肌缺陷的存在，并测量缺陷大小。分析同一括约肌水平上最大缺陷角度大小。如果缺陷>30°，则认为是显著的。使用 EAUS 作为参考标准，计算 κ 系数（κ）、组内相关系数和测量标准误差（SEM）。
在每周间隔扫描的 73 名女性中，共进行了 250 次 EAUS 和 250 次 TPUS 扫描。在 55 次 EAUS 图像（22.0%）和 47 次 TPUS 图像（18.8%）中发现了 EAS 缺陷。在两种方式下，均在 26 次图像（10.4%）中发现了 IAS 缺陷。TPUS 在诊断 EAS 缺陷存在方面与 EAUS 具有极好的一致性（κ=0.87），在诊断 IAS 缺陷存在方面具有完美的一致性（κ=1.00）。TPUS 在休息时测量 EAS 和 IAS 缺陷大小与 EAUS 的一致性分别为较差和中度，相应的 SEM 分别为±16.1°和±27.9°。TPUS 在最大 PFMC 时测量 EAS 和 IAS 缺陷大小与 EAUS 的一致性分别为较差和中度，相应的 SEM 分别为±16.5°和±26.4°。基于 SEM，如果将 30°的诊断截止值用于 TPUS 上的缺陷大小，那么使用 EAUS 作为参考标准，约 9%-36%的女性可能会出现 EAS 缺陷的错误诊断，约 4%-15%的女性可能会出现 IAS 缺陷的错误诊断。
这是第一项直接比较 EAUS 和 TPUS 测量的肛门括约肌缺陷角度的研究。在 TPUS 检查中，不应使用 30°的角度截断值来诊断显著的残余肛门括约肌缺陷。需要进一步研究来确定 TPUS 的最佳缺陷截断角度。© 2022 作者。超声在妇产科由 John Wiley & Sons Ltd 出版，代表国际妇产科超声学会。
