Fecal incontinence in scleroderma: assessment of the anal sphincter with thin-section endoanal MR imaging.
OBJECTIVE
To compare the magnetic resonance (MR) imaging appearance of the anal sphincter in patients with fecal incontinence and scleroderma with that in patients with fecal incontinence alone, scleroderma alone, or neither.


METHODS
The study population comprised 14 patients with fecal incontinence and scleroderma, four with scleroderma alone, 13 with incontinence alone, and six with neither. T1- and T2-weighted spin-echo, magnetization transfer contrast-weighted, and dynamic gadolinium-enhanced images were obtained and analyzed for the integrity, thickness, and length of sphincter components. Magnetization transfer contrast ratios and T2 were calculated to assess fibrosis of the internal sphincter. The percentage enhancement above baseline was calculated at 30-second intervals for the internal and the external sphincter.


RESULTS
Eleven patients with incontinence and scleroderma showed descent of rectal air and feces into the anterior anal canal, with forward deviation of the significantly (P < .05) atrophied internal sphincter, which showed a slower gadolinium-enhancement pattern compared with that in other groups. Patients with incontinence alone showed no evidence of internal sphincter deviation or altered vascularity but had a significant reduction (P < .05) in deep external sphincter bulk.


CONCLUSIONS
In patients with fecal incontinence and scleroderma, endoanal MR imaging helps delineate the anterior sphincter deformity and shows the slower gadolinium-enhancement pattern on dynamic studies of the internal sphincter.
Robert Steiner MR Unit, Imperial College School of Medicine, Hammersmith Hospital, London, England.
N M
NM
deSouza
A D
AD
Williams
H J
HJ
Wilson
D J
DJ
Gilderdale
G A
GA
Coutts
C M
CM
Black
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000473:pathology* / Q000503:physiopathology; D003287:Contrast Media; D004867:Equipment Design; D005242:Fecal Incontinence / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000295:instrumentation*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D020700:Proctoscopes; D012007:Rectum / Q000473:pathology / Q000503:physiopathology; D012595:Scleroderma, Systemic / Q000175:diagnosis* / Q000503:physiopathology; D012680:Sensitivity and Specificity
D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA