title: The diagnostic accuracy of endovaginal and transperineal ultrasound for detecting anal sphincter defects: The PREDICT study.
abstract: OBJECTIVE
  To determine the accuracy and predictive value of transperineal (TPU) and endovaginal ultrasound (EVU) in the detection of anal sphincter defects in women with obstetric anal sphincter injuries and/or postpartum symptoms of faecal incontinence.
  
  
  METHODS
  One hundred and sixty-five women were recruited, four women were excluded as they were seen years after their last delivery. TPU and EVU, followed by endonanal ultrasound (EAU), were performed using the B&K Viking 2400 scanner. Sensitivity and specificity, as well as predictive values with 95% confidence intervals, for detecting anal sphincter defects were calculated for EVU and TPU, using EAU as the reference standard.
  
  
  RESULTS
  On EAU a defect was found in 42 (26%) women: 39 (93%) had an external (EAS) and 23 (55%) an internal anal sphincter (IAS) defect. Analysable images of one level of the EAS combined with an analysable IAS were available in 140 (87%) women for EVU and in 131 (81%) for TPU. The sensitivity and specificity for the detection of any defect was 48% (30-67%) and 85% (77-91%) for EVU and 64% (44-81%) and 85% (77-91%) for TPU, respectively.
  
  
  CONCLUSIONS
  Although EAU using a rotating endoprobe is the validated reference standard in the identification of anal sphincter defects, it is not universally available. However while TPU and/or EVU with conventional ultrasound probes can be useful in identifying normality, for clinical purposes they are not sensitive enough to identify an underlying sphincter defect.
authors: Department of Obstetrics and Gynaecology, Mayday University Hospital, Croydon, UK. annemarie.roos@gmail.com
authors: A-M
authors: AM
authors: Roos
authors: Z
authors: Z
authors: Abdool
authors: A H
authors: AH
authors: Sultan
authors: R
authors: R
authors: Thakar
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000293:injuries*; D036861:Delivery, Obstetric / Q000009:adverse effects*; D019160:Endosonography / Q000379:methods*; D005242:Fecal Incontinence / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D006801:Humans; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014621:Vagina / Q000000981:diagnostic imaging; D055815:Young Adult