García-Mejido José Antonio, García Pombo Sara, Fernández-Conde Cristina, Fernández-Palacín Ana, Borrero Carlota, Sainz-Bueno José Antonio
Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain.
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Seville, Seville, Spain.
Quant Imaging Med Surg. 2023 Mar 1;13(3):1664-1671. doi: 10.21037/qims-22-714. Epub 2023 Jan 2.
The anorectal angle (ARA) has been assessed with different imaging methods and its measurement has traditionally been based on defecography or magnetic resonance studies. Different ultrasound methodologies have also been used for ARA assessment and have been validated as alternatives for the ARA measurement, such as three-dimensional (3D) endovaginal ultrasound and 3D transperineal ultrasound. 3D transperineal ultrasound does not require the introduction of ultrasound transducers inside the anal canal. Therefore, it is reasonable to think that the use of transperineal ultrasound can provide more reproducible ARA measurements, something that has not been established by 3D endovaginal probe or defecography. Our objective is to determine the intraobserver and interobserver variability of transperineal ultrasound for the assessment of ARA.
A retrospective observational study was performed with 40 patients. The study of the ARA was performed from the mid-sagittal plane (at rest, Valsalva and maximum contraction), visualizing the anorectal canal, the anorectal junction and the rectal ampulla. ARA measurements were performed initially by explorer 1 (E1), subsequently by explorer 2 (E2) and finally again by E1. Intraobserver and interobserver variability was calculated by calculating the intraclass correlation coefficient (ICC) with 95% confidence interval (CI).
Intraobserver variability was excellent for all measurements of the ARA at rest, Valsalva and maximal contraction, with ICC ranging from 0.968 to 0.975. Interobserver variability was also superb for all measurements of the ARA at rest, Valsalva and maximal contraction, with ICC ranging from 0.971 to 0.979.
Intraobserver and interobserver variability were excellent for the ARA measurements by transperineal ultrasound.
已采用不同的成像方法评估肛管直肠角（ARA），其测量传统上基于排粪造影或磁共振研究。不同的超声方法也已用于ARA评估，并已被验证可作为ARA测量的替代方法，如三维（3D）经阴道超声和3D经会阴超声。3D经会阴超声不需要将超声换能器插入肛管内。因此，有理由认为经会阴超声的使用可以提供更可重复的ARA测量结果，而这一点尚未通过3D经阴道探头或排粪造影得到证实。我们的目的是确定经会阴超声评估ARA时的观察者内和观察者间变异性。
对40例患者进行了一项回顾性观察研究。从矢状中平面（静息、瓦尔萨尔瓦动作和最大收缩时）对ARA进行研究，观察肛管、肛管直肠交界处和直肠壶腹。ARA测量最初由检查者1（E1）进行，随后由检查者2（E2）进行，最后再由E1进行。通过计算具有95%置信区间（CI）的组内相关系数（ICC）来计算观察者内和观察者间变异性。
在静息、瓦尔萨尔瓦动作和最大收缩时，ARA的所有测量中观察者内变异性均极佳，ICC范围为0.968至0.975。在静息、瓦尔萨尔瓦动作和最大收缩时，ARA的所有测量中观察者间变异性也极佳，ICC范围为0.971至0.979。
经会阴超声测量ARA时，观察者内和观察者间变异性均极佳。
