Keywords:
Pelvic floor dysfunction, Defecography, Conventional radiography, MR, Pelvis, Gastrointestinal tract
Authors:
A. C. C. BRANDAO, L. Oliveira; rio de janeiro, RJ/BR
DOI:
10.1594/ecr2013/C-1235
Methods and Materials
20 patients with symptoms of obstructed defecation,
anal incontinence and pelvic floor descend were examined by a closed 1,5T magnet,
in supine position,
and with conventional defecography method.
Preparation: Patients were prepared with an enema at least two hours before evaluation and 4 hours fasting.
DMRD method: 250 ml of ultrasound gel are introduced into the rectum to simulate the presence of feces and 10 ml for opacification of the vagina.
There is no need for opacification of the urethra.
In the MR table,
at the supine position,
patients were asked to flex their knees and it was placed a pillow underneath to facilitate expulsion of the rectal contrast.
Images were acquired using cardiac phased-array coil.
The dynamic FIESTA sequence (valsalva,
squeeze and defecation maneuvers) were performed in a mid-sagittal plane and the field of view included the three compartments of the pelvis,
as well as the pubis and sacrococcygeal joint.
Sagital,
axial and coronal T2-weighted high resolution sequences were performed during rest allowing anatomic assessment.
Conventional defecography method: 250 ml of liquid and a barium paste were introduced and patients were positioned in a special comode in right lateral position.
Their were asked to evacuate the rectal content while dynamic evaluation was obtained.
Parameters analyzed: anorectal angle,
anal canal opening,
perineal descent,
rectal emptying,
number of attempts,
involuntary losses,
external sphincter,
pubococcygeal line and the presence of pathological findings (rectocele,
enterocele,
intussusception,
anismus,
and perineal descent).
In order to verify the degree of agreement among observers,
for both exams,
the Kappa Index Concordance was utilized.
In addition,
correlation was evaluated using Fisher´s Exact Test.