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International Journal of Colorectal Disease

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01-06-2008 | Original Article

Diagnostic precision of endoanal MRI in the detection of anal sphincter pathology—a meta-analysis

Authors: Emile Tan, Ann Anstee, Dow-Mu Koh, Wadyslaw Gedroyc, Paris P. Tekkis

Published in: International Journal of Colorectal Disease | Issue 6/2008

Abstract

Objective

This study aims to evaluate the diagnostic precision of endoanal magnetic resonance imaging in identifying anal sphincter injury and/or atrophy when compared with either endoanal ultrasound or surgical diagnosis.

Materials and methods

Quantitative meta-analysis was performed on nine studies, comparing endoanal MRI with endoanal ultrasound or surgical diagnosis in 157 patients. Sensitivity, specificity, and diagnostic odds ratio were calculated for each study. Summary receiver operating characteristic curves (SROC) and subgroup analysis were undertaken.

Results

The overall sensitivity and specificity of endoanal MRI for external sphincter injury was 0.78 (95%CI: 0.66–0.84) and 0.66 (95%CI: 0.51–0.79), respectively. For internal sphincter injury detection, this was 0.63 (95%CI: 0.50–0.74) and 0.71 (95%CI: 0.60–0.81), respectively. For detection of atrophy, this was 0.86 (95%CI: 0.71–0.95) and 0.82 (95%CI: 0.65–0.93), respectively. The area under the SROC curve and diagnostic odds ratio were 0.84 (SE = 0.07) and 6.14 (95%CI: 2.17–17.4) for external sphincter injury, 0.79 (SE = 0.07) and 4.60 (95%CI: 1.75–12.15) for internal sphincter injury, and 0.92 (SE = 0.08) and 21.49 (95%CI: 2.87–160.64) for sphincter atrophy.

Conclusion

Endoanal MRI was sensitive and specific for the detection of external sphincter injury and especially sphincter atrophy. It may be useful as an alternative to endoanal ultrasound in patients presenting with fecal incontinence, although further clinical studies are needed to identify its best application in clinical practice.

Bharucha AE (2004) Outcome measures for fecal incontinence: anorectal structure and function. Gastroenterology 126(1 Suppl 1):S90–98PubMedCrossRef

Fuchsjager MH, Maier AG (2003) Imaging fecal incontinence. Eur J Radiol 47(2):108–116PubMedCrossRef

Sorensen M, Tetzschner T, Rasmussen OO, Bjarnesen J, Christiansen J (1993) Sphincter rupture in childbirth. Br J Surg 80(3):392–394PubMedCrossRef

Sultan AH, Kamm MA, Hudson CN, Bartram CI (1994) Third degree obstetric anal sphincter tears: risk factors and outcome of primary repair. Bmj 308(6933):887–891PubMed

Bharucha AE (2006) Update of tests of colon and rectal structure and function. J Clin Gastroenterol 40(2):96–103PubMedCrossRef

Bartram CI, Sultan AH (1995) Anal endosonography in faecal incontinence. Gut 37(1):4–6PubMedCrossRef

Beets-Tan RG, Morren GL, Beets GL, Kessels AG, el Naggar K, Lemaire E et al (2001) Measurement of anal sphincter muscles: endoanal US, endoanal MR imaging, or phased-array MR imaging? A study with healthy volunteers. Radiology 220(1):81–89PubMed

Enck P, Heyer T, Gantke B, Schmidt WU, Schafer R, Frieling T et al (1997) How reproducible are measures of the anal sphincter muscle diameter by endoanal ultrasound? Am J Gastroenterol 92(2):293–296PubMed

Gold DM, Halligan S, Kmiot WA, Bartram CI (1999) Intraobserver and interobserver agreement in anal endosonography. Br J Surg 86(3):371–375PubMedCrossRef

10.

Malouf AJ, Williams AB, Halligan S, Bartram CI, Dhillon S, Kamm MA (2000) Prospective assessment of accuracy of endoanal MR imaging and endosonography in patients with fecal incontinence. AJR Am J Roentgenol 175(3):741–745PubMed

11.

Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM et al (2003) Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. Bmj 326(7379):41–44PubMedCrossRef

12.

Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J (2003) The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 3:25PubMedCrossRef

13.

Littenberg B, Moses LE (1993) Estimating diagnostic accuracy from multiple conflicting reports: a new meta-analytic method. Med Decis Making 13(4):313–321PubMedCrossRef

14.

Moses LE, Shapiro D, Littenberg B (1993) Combining independent studies of a diagnostic test into a summary ROC curve: data-analytic approaches and some additional considerations. Stat Med 12(14):1293–1316PubMedCrossRef

15.

Walter SD (2002) Properties of the summary receiver operating characteristic (SROC) curve for diagnostic test data. Stat Med 21(9):1237–1256PubMedCrossRef

16.

Irwig L, Tosteson AN, Gatsonis C, Lau J, Colditz G, Chalmers TC et al (1994) Guidelines for meta-analyses evaluating diagnostic tests. Ann Intern Med 120(8):667–676PubMed

17.

Jaeschke R, Guyatt G, Sackett DL (1994) Users' guides to the medical literature. III. How to use an article about a diagnostic test. A. Are the results of the study valid? Evidence-Based Medicine Working Group. Jama 271(5):389–391PubMedCrossRef

18.

Buhr HJ, Kroesen AJ (2003) [The importance of diagnostics in faecal incontinence. Endosonography]. Chirurg 74(1):4–14PubMedCrossRef

19.

Frudinger A, Buchanan G, Halligan S (2003) Endoanal MR imaging: diagnostic assessment. Chirurg 74(1):20–25PubMedCrossRef

20.

Maier A, Fuchsjager M, Funovics M (2000) Endoanal magnetic resonance tomography in fecal incontinence. Radiologe 40(5):465–468PubMedCrossRef

21.

Stoker J, Hussain SM, Lameris JS (1996) Endoanal magnetic resonance imaging versus endosonography. Radiol Med (Torino) 92(6):738–741

22.

Williams AB, Bartram CI, Halligan S, Marshall MM, Nicholls RJ, Kmiot WA (2002) Endosonographic anatomy of the normal anal canal compared with endocoil magnetic resonance imaging. Dis Colon Rectum 45(2):176–183PubMedCrossRef

23.

Briel JW, Zimmerman DD, Stoker J, Rociu E, Lameris JS, Mooi WJ et al (2000) Relationship between sphincter morphology on endoanal MRI and histopathological aspects of the external anal sphincter. Int J Colorectal Dis 15(2):87–90PubMedCrossRef

24.

Cazemier M, Terra MP, Stoker J, de Lange-de Klerk ES, Boeckxstaens GE, Mulder CJ et al (2006) Atrophy and defects detection of the external anal sphincter: comparison between three-dimensional anal endosonography and endoanal magnetic resonance imaging. Dis Colon Rectum 49(1):20–27PubMedCrossRef

25.

deSouza NM, Puni R, Zbar A, Gilderdale DJ, Coutts GA, Krausz T (1996) MR imaging of the anal sphincter in multiparous women using an endoanal coil: correlation with in vitro anatomy and appearances in fecal incontinence. AJR Am J Roentgenol 167(6):1465–1471PubMed

26.

Fletcher JG, Busse RF, Riederer SJ, Hough D, Gluecker T, Harper CM et al (2003) Magnetic resonance imaging of anatomic and dynamic defects of the pelvic floor in defecatory disorders. Am J Gastroenterol 98(2):399–411PubMedCrossRef

27.

Pinta T, Kylanpaa ML, Luukkonen P, Tapani E, Kivisaari A, Kivisaari L (2004) Anal incontinence: diagnosis by endoanal US or endovaginal MRI. Eur Radiol 14(8):1472–1477PubMedCrossRef

28.

Rociu E, Stoker J, Eijkemans MJ, Schouten WR, Lameris JS (1999) Fecal incontinence: endoanal US versus endoanal MR imaging. Radiology 212(2):453–458PubMed

29.

West RL, Dwarkasing S, Briel JW, Hansen BE, Hussain SM, Schouten WR et al (2005) Can three-dimensional endoanal ultrasonography detect external anal sphincter atrophy? A comparison with endoanal magnetic resonance imaging. Int J Colorectal Dis 20(4):328–333PubMedCrossRef

30.

Dobben AC, Terra MP, Slors JF, Deutekom M, Gerhards MF, Beets-Tan RG et al (2007) External anal sphincter defects in patients with fecal incontinence: comparison of endoanal MR imaging and endoanal US. Radiology 242(2):463–471PubMedCrossRef

31.

Rociu E, Stoker J, Zwamborn AW, Lameris JS (1999) Endoanal MR imaging of the anal sphincter in fecal incontinence. Radiographics 19:S171–S177PubMed

32.

Begg CB, McNeil BJ (1988) Assessment of radiologic tests: control of bias and other design considerations. Radiology 167(2):565–569PubMed

33.

Law PJ, Kamm MA, Bartram CI (1990) A comparison between electromyography and anal endosonography in mapping external anal sphincter defects. Dis Colon Rectum 33(5):370–373PubMedCrossRef

34.

Law PJ, Kamm MA, Bartram CI (1991) Anal endosonography in the investigation of faecal incontinence. Br J Surg 78(3):312–314PubMedCrossRef

35.

Romano G, Rotondano G, Esposito P, Pellecchia L, Novi A (1996) External anal sphincter defects: correlation between pre-operative anal endosonography and intraoperative findings. Br J Radiol 69(817):6–9PubMedCrossRef

36.

Terra MP, Beets-Tan RG, van der Hulst VP, Deutekom M, Dijkgraaf MG, Bossuyt PM et al (2006) MRI in evaluating atrophy of the external anal sphincter in patients with fecal incontinence. AJR Am J Roentgenol 187(4):991–999PubMedCrossRef

37.

Terra MP, Beets-Tan RG, van Der Hulst VP, Dijkgraaf MG, Bossuyt PM, Dobben AC et al (2005) Anal sphincter defects in patients with fecal incontinence: endoanal versus external phased-array MR imaging. Radiology 236(3):886–895PubMedCrossRef

38.

deSouza NM, Kmiot WA, Puni R, Hall AS, Burl M, Bartram CI et al (1995) High resolution magnetic resonance imaging of the anal sphincter using an internal coil. Gut 37(2):284–287PubMedCrossRef

39.

West RL, Felt-Bersma RJ, Hansen BE, Schouten WR, Kuipers EJ (2005) Volume measurements of the anal sphincter complex in healthy controls and fecal-incontinent patients with a three-dimensional reconstruction of endoanal ultrasonography images. Dis Colon Rectum 48(3):540–548PubMedCrossRef

40.

Briel JW, Stoker J, Rociu E, Lameris JS, Hop WC, Schouten WR (1999) External anal sphincter atrophy on endoanal magnetic resonance imaging adversely affects continence after sphincteroplasty. Br J Surg 86(10):1322–1327PubMedCrossRef

41.

Gold DM, Bartram CI, Halligan S, Humphries KN, Kamm MA, Kmiot WA (1999) Three-dimensional endoanal sonography in assessing anal canal injury. Br J Surg 86(3):365–370PubMedCrossRef

42.

deSouza NM, Puni R, Gilderdale DJ, Bydder GM (1995) Magnetic resonance imaging of the anal sphincter using an internal coil. Magn Reson Q 11(1):45–56PubMed

Title: Diagnostic precision of endoanal MRI in the detection of anal sphincter pathology—a meta-analysis
Authors: Emile Tan
Ann Anstee
Dow-Mu Koh
Wadyslaw Gedroyc
Paris P. Tekkis
Publication date: 01-06-2008
Publisher: Springer-Verlag
Published in: International Journal of Colorectal Disease / Issue 6/2008
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-008-0449-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Diagnostic precision of endoanal MRI in the detection of anal sphincter pathology—a meta-analysis

Abstract

Objective

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Materials and methods

Results

Conclusion

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