Vora Haily, Lacy Brian
Division of Gastroenterology and Hepatology, Mayo Clinic in Florida, Jacksonville, Florida, USA.
Neurogastroenterol Motil. 2025 Aug 11:e70131. doi: 10.1111/nmo.70131.
Investigation of an evacuation disorder is often pursued in patients with symptoms of obstructive defecation. High-resolution anorectal manometry (HR-ARM) is a simple, safe, and widely available test to diagnose pelvic floor dysfunction. A more costly and less accessible test is magnetic resonance defecography (MRD). This study aims to quantify the added value of MRD in diagnosing pelvic floor disorders.
HR-ARM and MRD performed in patients with a diagnosis of constipation between January 1, 2020 and May 15, 2022 at Mayo Clinic were identified using Epic Slicer Dicer. Univariate and multivariate analyses were used to compare findings on MRD in patients with and without abnormal HR-ARM. Categorical variables were compared using the Pearson's chi-square test, and continuous variables were compared using the two-sample t-test.
Seventy-six consecutive patients (81.8% female, 94.8% White, ages 19-82) who underwent both HR-ARM and MRD were included. The majority had evidence of dyssynergia on HR-ARM (n = 49, 64.5%). Patients with dyssynergia on HR-ARM were significantly more likely to have prolonged balloon expulsion at both > 60 and > 30 s (p < 0.001) and incomplete gel expulsion on MRD (p < 0.001). However, they were not more likely to have a clinically significant rectocele measuring > 2 cm (p = 0.17) or evidence of rectal prolapse (p = 0.07).
Anatomic findings on MRD were similar between patients with and without evidence of dyssynergia identified by HR-ARM. In this retrospective review, simultaneously undergoing MRD in addition to HR-ARM does not appear to provide significant additional diagnostic information to guide therapeutic recommendations. Large prospective studies to evaluate the added value of MRD are needed.
对于有排便梗阻症状的患者，常需对排空障碍进行调查。高分辨率肛肠测压法（HR-ARM）是一种用于诊断盆底功能障碍的简单、安全且广泛可用的检查方法。一种成本更高且较难获得的检查方法是磁共振排粪造影（MRD）。本研究旨在量化MRD在诊断盆底疾病中的附加价值。
使用Epic Slicer Dicer识别2020年1月1日至2022年5月15日在梅奥诊所被诊断为便秘的患者所进行的HR-ARM和MRD检查。采用单因素和多因素分析比较HR-ARM异常和无异常患者的MRD检查结果。分类变量采用Pearson卡方检验进行比较，连续变量采用两样本t检验进行比较。
纳入了76例连续接受HR-ARM和MRD检查的患者（女性占81.8%，白人占94.8%，年龄19 - 82岁）。大多数患者在HR-ARM检查中有不协调排便的证据（n = 49，64.5%）。HR-ARM检查存在不协调排便的患者在球囊排出时间>60秒和>30秒时更有可能出现排出时间延长（p < 0.001），且在MRD检查中更有可能出现凝胶排出不完全（p < 0.001）。然而，他们出现测量值>2 cm的具有临床意义的直肠膨出（p = 0.17）或直肠脱垂证据（p = 0.07）的可能性并不更高。
HR-ARM检查有或无不协调排便证据的患者在MRD检查中的解剖学发现相似。在这项回顾性研究中，除HR-ARM外同时进行MRD检查似乎并未提供显著的额外诊断信息以指导治疗建议。需要进行大型前瞻性研究以评估MRD的附加价值。
