Research Article
Volume 8 Issue 3 - 2021
MR-Defecography: Which Protocol is Most Appropriate?
Vittorio Piloni1,2,3,4*, Marco Vernelli1, Vincenzo Civitella2, Giampietro Giomo3 and Tommaso Felici4
1Centro Diagnostico N. Aliotta Villa Silvia, Senigallia, Ancona, Italy
2Studio Ronconi, viale Francesco Saverio Altamura, Acilia, Rome, Italy
3Affidea Iniziativa Medica - Diagnostic Imaging Centre, Monselice, Padua, Italy
4Diagnostica Marche, Osimo Stazione, Ancona, Italy
*Corresponding Author: Vittorio Piloni, Centro Diagnostica Marche, Osimo stazione, Ancona, Italy.
Received: January 25, 2021; Published: February 27, 2021




Abstract

Aim: To highlight the advantages of one method for performing magnetic resonance defecography (MRD) over other three variants based on the total amount of information extracted from the examination.

Materials and Methods: The imaging series of sixty patients (39 females, 21 males, mean age 49 ± 5 yrs, range 18 - 83 yrs) referred for a variety of symptoms including obstructed defecation, fecal incontinence and pelvic organ prolapse, were randomly chosen from four different diagnostic centers (15 each). MRD studies were developed on a 1.5 T closed system imager in three centers and on a 0.3 T open system in one center. The image protocol varied over time in search for the best successful outcome of the examination, as follows: Protocol 1a = bladder half filled and static phase acquisition before rectal filling; Protocol 1b = bladder half filled and static phase acquisition after rectal filling; Protocol 2a = bladder empty and static phase acquisition before rectal filling; Protocol 2b = bladder empty and static phase after rectal filling. The null hypothesis under test was that each protocol would produce the same result in terms of diagnostic yield, defined as the total amount of information obtained from the combined analysis of both static and dynamic series. This was measured by calculating the frequency with which various abnormalities and normal structures were recognized (or missed). Differences among protocols were considered significant at a p-value of < 0.05.

Results: The highest diagnostic yield for depiction of pelvic anatomy was obtained by Protocol 2a and use of 1.5T magnets (28/45, 62.2%). Regardless of the overall image quality and conspicuity of changes, the detection rate of functional abnormalities by 0.3 T did not differ significantly from that of 1.5 T equipments (13/15, 80% vs 41/45, 91.1%). The amount and dilution of contrast administration were dictated by the specific clinical question, whether obstructive defecation, fecal incontinence or pelvic organ prolapse.

Conclusion: (1) The best MRD protocol is to visualize the undisturbed pelvic anatomy first, i.e. with the bladder and rectum empty and to adapt contrast administration to the specific complaint; (2) although preferable, using a 1.5 T MR equipment is mandatory only for optimal depiction of pelvic anatomy.

 Keywords: Magnetic Resonance Defecography; High Field-Strength Magnet; Pelvic Floor Dysfunctions; Obstructive Defecation Syndrome; Pelvic Floor Imaging; Fecal Incontinence; Pelvic Organ Prolapse

References

    1. Yang A., et al. “Pelvic floor descent in women: dynamic evaluation with fast MR imaging and cinematic display”. Radiology 179 (1991): 25-33.
    2. Ekberg O., et al “Defecography: dynamic radiological imaging in proctology”. Gastroenterologist International 3 (1990) 93-99.
    3. Andrade LC, et al. “Conventional videodefecography: pathologic findings according to gender and age”. European Journal of Radiology 1 (2015): 1-5.
    4. Martín-Martín GP. et al. “Magnetic resonance defecography versus videodefecography in the study of obstructed defecation syndrome: Is videodefecography still the test of choice after 50 years?” Techniques in Coloproctology 10 (2017): 795-780.
    5. Beer-Gabel M., et al. “Dynamic transperineal ultrasound vs. defecography in patients with evacuatory difficulty: a pilot study”. The International Journal of Colorectal Disease 1 (2004): 60-67.
    6. Piloni V., et al. “Evacuation sonography”. Techniques in Coloproctology 9 (2005): 119-126.
    7. Lienemann A., et al. “Dynamic MR colpocystorectography assessing pelvic floor descent”. European Radiology 7 (1997): 1309-1317.
    8. Healey JC., et al. “Dynamic MR imaging compared with evacuation proctography when evaluating anorectal configuration and pelvic floor movement”. American Journal of Roentgenology 3 (1997): 775-779.
    9. Fielding JR., et al. “MR imaging of pelvic floor continence mechanisms in the supine and sitting positions”. American Journal of Roentgenology 6 (1998): 1607-1610.
    10. Kelvin , et al. “ Female pelvic organ prolapse: a comparison of triphasic dynamic MR imaging and triphasic fluoroscopic cystocolpoproctography”. American Journal of Roentgenology 174.1 (2000): 81-88.
    11. Bertschinger KM., et al. “Dynamic MR imaging of the pelvic floor performed with patient sitting in an open-magnet unit versus. with patient supine in a closed-magnet unit”. Radiology 2(2002): 501-508.
    12. Dvorkin LS., et al. “Open-magnet MR defecography compared with evacuation proctography in the diagnosis and management of patients with rectal intussusception”. Colorectal Disease 6 (2004): 45-53.
    13. Ramage L., et al. “Magnetic resonance defecography versus clinical examination and fluoroscopy: a systematic review and meta-analysis”. Techniques in Coloproctology 12 (2017): 915-927.
    14. Comiter C.V., et al. “Grading pelvic prolapse and pelvic floor relaxation using dynamic magnetic resonance imaging”. Urology3 (1999): 454-457.
    15. Maglinte DDT., et al. “Association of compartment defects in pelvic floor dysfunction”. American Journal of Roentgenology 172 .2 (1999): 439-444.
    16. Pannu HK., et al. “Dynamic MR imaging of pelvis organ prolapse: spectrum of abnormalities”. Radio Graphics6 (2000): 1567-1582.
    17. Fielding JR. “Practical MR imaging of female pelvic floor weakness”. Radiographics 22 (2002): 295-304.
    18. Cortes E., et al. “Clinical examination and dynamic magnetic resonance imaging in vaginal vault prolapse”. Obstetrics and Gynecology 103 (2004): 41-46.
    19. DeLancey JOL. “Structural anatomy of the posterior pelvic compartment as it relates to rectocele”. American Journal of Obstetrics and Gynecology 180 (1999): 815-823.
    20. Myers RP., et al. “Puboperineales: muscular boundaries of the male urogenital hiatus in 3D magnetic resonance imaging”. The Journal of Urology 164 (2000): 1412-1415.
    21. Tunn R., et al. “Visibility of pelvic organ support system structures in magnetic resonance images without and endovaginal coil”. American Journal of Obstetrics and Gynecology 184 (2001): 1156-1163.
    22. Chou Q., et al. “A structured system to evaluate urethral support anatomy in magnetic resonance images”. American Journal of Obstetrics and Gynecology 185 (2001): 44-50.
    23. Tunn R., et al. “Anatomic variation in the levator ani muscle, endopelvic fascia, and urethra in nulliparas evaluated by magnetic resonance”. American Journal of Obstetrics and Gynecology 188 (2003): 116-121.
    24. Brown G., et al. “High resolution MRI of the anatomy important in total mesorectal excision of the Rectum”. American Journal of Roentgenology 182 (2004): 431-439.
    25. El Sayed RF., et al. “Magnetic resonance imaging of pelvic floor dysfunction-joint recommendations of the ESUR and ESGAR Pelvic Floor Working Group”. European Radiology 5 (2017): 2067-2085.
    26. Piloni V., et al. “MR-defecography in obstructed defecation syndrome (ODS): technique, diagnostic criteria and grading”. Techniques in Coloproctology 5 (2013): 501-510.
    27. Piloni V., et al. “The radiologic assessment of the functional disorders of the anorectal junction: a specific look at the pelvic floor and mechanism of defecation” . in Abdomen and Gastrointestinal Tract. Capesius P (ed) Interimages 1984, GI O 12:6 Luxembourg . Proceedings of the XVth ICR 81, Brussels (1981).
    28. Piloni V., et al. “Fusion imaging by transperineal sonography/magnetic resonance in patients with fecal blockade syndrome”. EC Gastroenterology and Digestive System1 (2018): 11-16.
    29. Piloni V., et al. “The clinical value of magnetic resonance defecography in males with obstructed defecation syndrome”. Techniques in Coloproctology3 (2018): 179-190.
    30. Piloni V., et al. “Biphasic MRI Examination of Fecal Incontinence with External Coil: Technique and Clinical Applications”. EC Gastroenterology and Digestive System8 (2019): 725-735.
    31. Gurland B., et al. “Proceedings of the Consensus Meeting of the Pelvic Floor Disorders Consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the International Continence Society, The American Urogynecologic Society, the International Urogynecological Association, and the Society of Gynecologic Surgeons”. Part 2: Consensus Definitions and Interpretations Templates for Magnetic Resonance Imaging of Defecatory Pelvic Floor Disorders”. Diseases of the Colon and Rectum DCR-D-20-01194.
Citation: Vittorio Piloni., et al. “MR-Defecography: Which Protocol is Most Appropriate?”. EC Gastroenterology and Digestive System 8.3 (2021): 169-178.

PubMed Indexed Article


EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005


EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777


EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347


EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478


EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253


EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033


EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992


EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505


EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793


EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211


EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047


EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560


EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318


EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819


EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840


EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344


EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476


EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658


EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489


EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278


EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108


EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571


EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333


EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883


EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001


EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937


EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723


EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726


EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603


EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646


EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616


EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290


EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226


EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812


EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268


News and Events


May Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the May issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for upcoming Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before May 28, 2021.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to editor@ecronicon.uk