Document Detail


Semi-automated vectorial analysis of anorectal motion by magnetic resonance defecography in healthy subjects and fecal incontinence.
MedLine Citation:
PMID:  22765510     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Inter-observer variability limits the reproducibility of pelvic floor motion measured by magnetic resonance imaging (MRI). Our aim was to develop a semi-automated program measuring pelvic floor motion in a reproducible and refined manner.
METHODS: Pelvic floor anatomy and motion during voluntary contraction (squeeze) and rectal evacuation were assessed by MRI in 64 women with fecal incontinence (FI) and 64 age-matched controls. A radiologist measured anorectal angles and anorectal junction motion. A semi-automated program did the same and also dissected anorectal motion into perpendicular vectors representing the puborectalis and other pelvic floor muscles, assessed the pubococcygeal angle, and evaluated pelvic rotation.
KEY RESULTS: Manual and semi-automated measurements of anorectal junction motion (r = 0.70; P < 0.0001) during squeeze and evacuation were correlated, as were anorectal angles at rest, squeeze, and evacuation; angle change during squeeze or evacuation was less so. Semi-automated measurements of anorectal and pelvic bony motion were also reproducible within subjects. During squeeze, puborectalis injury was associated (P ≤ 0.01) with smaller puborectalis but not pelvic floor motion vectors, reflecting impaired puborectalis function. The pubococcygeal angle, reflecting posterior pelvic floor motion, was smaller during squeeze and larger during evacuation. However, pubococcygeal angles and pelvic rotation during squeeze and evacuation did not differ significantly between FI and controls.
CONCLUSION & INFERENCES: This semi-automated program provides a reproducible, efficient, and refined analysis of pelvic floor motion by MRI. Puborectalis injury is independently associated with impaired motion of puborectalis, not other pelvic floor muscles in controls and women with FI.
Authors:
J Noelting; A E Bharucha; D S Lake; A Manduca; J G Fletcher; S J Riederer; L Joseph Melton; A R Zinsmeister
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2012-07-06
Journal Detail:
Title:  Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society     Volume:  24     ISSN:  1365-2982     ISO Abbreviation:  Neurogastroenterol. Motil.     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-09-12     Completed Date:  2013-06-04     Revised Date:  2013-10-17    
Medline Journal Info:
Nlm Unique ID:  9432572     Medline TA:  Neurogastroenterol Motil     Country:  England    
Other Details:
Languages:  eng     Pagination:  e467-75     Citation Subset:  IM    
Copyright Information:
© 2012 Blackwell Publishing Ltd.
Affiliation:
Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, Rochester, MN, USA.
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MeSH Terms
Descriptor/Qualifier:
Anal Canal / physiopathology*,  radiography
Case-Control Studies
Defecography / methods*
Fecal Incontinence / physiopathology*,  radiography
Female
Gastrointestinal Motility / physiology*
Humans
Magnetic Resonance Imaging / methods
Rectum / physiopathology*,  radiography
Grant Support
ID/Acronym/Agency:
1 UL1 RR024150/RR/NCRR NIH HHS; R01 AG034676/AG/NIA NIH HHS; R01 DK078924/DK/NIDDK NIH HHS; R01 DK78924/DK/NIDDK NIH HHS; R01-AG034676/AG/NIA NIH HHS; RR018898/RR/NCRR NIH HHS
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