MR defecography in patients with dyssynergic defecation: spectrum of imaging findings and diagnostic value.
OBJECTIVE
We describe the spectrum of findings and the diagnostic value of MR defecography in patients referred with suspicion of dyssynergic defecation.


METHODS
48 patients (34 females, 14 males; mean age 48 years) with constipation and clinically suspected dyssynergic defecation underwent MR defecography. Patients were divided into patients with dyssynergic defecation (n = 18) and constipated patients without dyssynergic defecation (control group, n = 30). MRIs were analysed for evacuation ability, time to initiate evacuation, time of evacuation, changes in the anorectal angle (ARA-change), presence of paradoxical sphincter contraction and presence of additional pelvic floor abnormalities. Sensitivity, specificity, positive and negative predictive values and accuracy for the diagnosis of dyssynergic defecation were calculated.


RESULTS
The most frequent finding was impaired evacuation, which was seen in 100% of patients with dyssynergic defecation and in 83% of the control group, yielding a sensitivity for MR defecography for the diagnosis of dyssynergic defecation of 100% (95% confidence interval (CI) 97-100%), but a specificity of only 23% (95% CI 7-40%). A lower sensitivity (50%; 95% CI 24-76%) and a high specificity (97%; 95% CI 89-100%) were seen with abnormal ARA-change. The sensitivity of paradoxical sphincter contraction was relatively high (83%; 95% CI 63-100%). A combined analysis of abnormal ARA-change and paradoxical sphincter contraction allowed for the detection of 94% (95% CI 81-100%) of the patients with dyssynergic defecation.


CONCLUSIONS
MR defecography detects functional and structural abnormal findings in patients with clinically suspected dyssynergic defecation. Impaired evacuation is seen in patients with functional constipation owing to other pelvic floor abnormalities than dyssynergic defecation.
Institute of Diagnostic Radiology, University Hospital Zürich, Switzerland. caecilia.reiner@gmx.at
C S
CS
Reiner
R
R
Tutuian
A E
AE
Solopova
D
D
Pohl
B
B
Marincek
D
D
Weishaupt
D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000503:physiopathology*; D001259:Ataxia / Q000175:diagnosis* / Q000503:physiopathology; D003672:Defecation / Q000502:physiology*; D019841:Defecography / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000592:standards; D008297:Male; D008875:Middle Aged; D017773:Pelvic Floor / Q000503:physiopathology; D012680:Sensitivity and Specificity; D055815:Young Adult
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