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04.08.2023 | Pelvis

Diagnostic performance of dynamic MR defecography in assessment of dyssynergic defecation

verfasst von: Pimpapon Thanaracthanon, Kewalee Sasiwimonphan, Angkana Sunthornram, Mukesh G. Harisinghani, Thitinan Chulroek

Erschienen in: Abdominal Radiology | Ausgabe 11/2023

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Abstract

Purpose

To assess diagnostic performance of MR defecographic findings in diagnosis of dyssynergic defecation (DD).

Methods

This retrospective study included 46 patients with chronic constipation who met the Rome IV criteria for diagnosis of present or absent DD and underwent MRI between Jan 2015 and June 2020. Patients were divided into DD group (n = 24) and non-DD group (n = 22). Nine parameters were analyzed by two radiologists: anorectal angle (ARA) and M line at rest, defecation, and change between 2 phases; anal canal width; prominent puborectalis muscle; abnormal evacuation. Receiver operating characteristic (ROC) curves were plotted to extract the optimal cut-offs and area under the curve (AUC). Multivariate analysis was performed.

Results

Seven findings showed statistically significant difference between DD and non-DD groups. M line at defecation had highest odds ratio, followed by ARA change, ARA at defecation, M line change, prominent puborectalis muscle, abnormal evacuation and anal canal width, respectively. ARA change and prominent puborectalis muscle had highest specificity (95.5% and 100%, respectively). The optimal cut-offs of ARA at defecation, ARA change, M line at defecation, M line change and anal canal width were 122°, 1.5°, 3.25 cm, 1.9 cm and 8.5 mm, respectively. Multivariate logistic regression revealed two significant findings in differentiating between DD and non-DD, including M line at defecation (OR 23.31, 95% CI 3.10–175.32) and ARA at defecation (OR 13.63, 95% CI 1.94–95.53) with sensitivity, specificity, PPV, NPV and AUC of 79.2%, 95.5%, 95%, 80.8% and 0.87(95% CI 0.78–0.97), respectively.

Conclusion

MR defecography has high diagnostic performance in diagnosis of DD. Although M line and ARA at defecation are two significant findings on multivariate analysis, ARA change less than 1.5 degrees and prominent puborectalis muscle have good specificity in DD diagnosis.

Graphical abstract

Literatur
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Metadaten
Titel
Diagnostic performance of dynamic MR defecography in assessment of dyssynergic defecation
verfasst von
Pimpapon Thanaracthanon
Kewalee Sasiwimonphan
Angkana Sunthornram
Mukesh G. Harisinghani
Thitinan Chulroek
Publikationsdatum
04.08.2023
Verlag
Springer US
Erschienen in
Abdominal Radiology / Ausgabe 11/2023
Print ISSN: 2366-004X
Elektronische ISSN: 2366-0058
DOI
https://doi.org/10.1007/s00261-023-04010-z

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