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


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


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Citation: Vittorio Piloni., et al. “MR-Defecography: Which Protocol is Most Appropriate?”. EC Gastroenterology and Digestive System 8.3 (2021): 169-178.

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