title: A novel two-dimensional dynamic anal ultrasonography technique to assess anismus comparing with three-dimensional echodefecography.
abstract: OBJECTIVE
  The aim of this prospective study was to test two-dimensional dynamic anorectal ultrasonography (2D-DAUS) in the assessment of anismus and compare it with echodefecography (ECD).
  
  
  METHODS
  Fifty consecutive female patients with outlet delay were submitted to 2D and 3D-DAUS, measuring the relaxing or contracting puborectalis muscle angle during straining. The patients were assigned to one of two groups based on ECD findings. Group I consisted of 29 patients without anismus and group II included 21 patients diagnosed with anismus. Subsequently 2D-DAUS images were checked for anismus and compared with ECD findings.
  
  
  RESULTS
  Upon straining, the angle produced by the movement of the puborectalis muscle decreased in 26 out of the 29 (89.6%) patients of group I and increased 19 out of the 21 (90.4%) patients of group II. The mean angle during straining differed significantly between group I and group II. The index of agreement between the two scanning modes was 89.6% (26/29) for group I (Kappa: 0.796; CI: 95%; range: 0.51-1.0) and 90.4% (19/21) for group II (Kappa: 0.796; CI: 95%; range: 0.51-1.0).
  
  
  CONCLUSIONS
  Two-dimensional dynamic anal ultrasonography can be used as an alternative method to assess patients with anismus, although the 3-D modality is more precise to evaluate the PR angle as the sphincters integrity as the whole muscle length is clearly visualized.
authors.affiliation: Department of Surgery, School of Medicine of the Federal University of Ceara, Ceará, Brazil. smregadas@hospitalsaocarlos.com.br
authors.forename: S M
authors.initials: SM
authors.lastname: Murad-Regadas
authors.forename: F S P
authors.initials: FS
authors.lastname: Regadas
authors.forename: R G L
authors.initials: RG
authors.lastname: Barreto
authors.forename: L V
authors.initials: LV
authors.lastname: Rodrigues
authors.forename: M H L P
authors.initials: MH
authors.lastname: de Souza
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000000981:diagnostic imaging*; D001004:Anus Diseases / Q000000981:diagnostic imaging*; D001259:Ataxia / Q000175:diagnosis; D003248:Constipation / Q000000981:diagnostic imaging; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008875:Middle Aged; D017773:Pelvic Floor / Q000000981:diagnostic imaging*; D055815:Young Adult