Keywords:
Pelvic floor dysfunction, Defecography, MR, Pelvis
Authors:
S. Camisa, F. Calliada, I. Fulle, G. Ori Belometti; Pavia/IT
DOI:
10.1594/ecr2013/C-2659
Methods and Materials
31 patients,
including 27 women (87.1%) and 4 men (12.9%) with mean age of 56 ± 12 years,
are enrolled for a 6-12 months follow-up protocol after STARR surgery.
Inclusion criteria:
• Patients 18-80 years old;
• Patients who performed MR-defecography in our Institute of Radiology before STARR,
with imaging diagnosis of rectocele and rectal prolapse .
Exclusion criteria:
• Patients with contraindications to MR exam;
• Patients with a history of drug addiction,
psychiatric disorders,
dementia,
or other reasons that may affect compliance during performing protocol;
• Patients with claustrophobia.
After enrolled,
one woman is excluded from the protocol because of a claustrophobia crisis,
so our results refer to 30 patients (26 women +4 men).
In order to standardize the follow-up monitoring and to quantify symptoms as constipation and incontinence,
clinical evaluation is carried out by two score systems: Cleveland Clinic Constipation Score (CCCS) [3] and Wexner Continence Grading Scale (WCGS) [4].
Although not recent,
these two score systems are easily usable by patients.
Before performing MR defecography,
it is necessary to distend rectal ampulla using ultrasonography gel (about 300 ml).
Patients are evaluated by MR-defecography using 1.5 Tesla MRI system and surface multichannel coil “phased arrey” for signal reception.
MR-defecography consists of two phases: static and dynamic ones [5-6].
Static phase includes Turbo Spin Echo (TSE) T2-w sequences on axial and sagictal planes (Fig.
1) and a TSE T1-w sequence on coronal plane (Fig.
2).
These rest sequences ensure a morphological study of puborectal and levator ani muscles and a functional assessment of anorectal angle.
In the next dynamic phase True FISP sequences on sagictal plane are used,
performed during squeezing (voluntary contraction of external anorectal sphincter) (Fig.
3) and during gel evacuation (Fig.4).