title: Spinal ultrasound in patients with anorectal malformations: is this the end of an era?
abstract: OBJECTIVE
  Even if lumbar magnetic resonance imaging (MRI) is considered the gold standard in the diagnosis of occult spinal dysraphism (SD) in patients with anorectal malformations (ARMs), spinal ultrasound (US) performed up to 5 months of life have been largely used as a screening test. The aim of the present study was to evaluate the accuracy in terms of sensibility and specificity of neonatal US to detect occult SD in patients with ARMs.
  
  
  METHODS
  Retrospective analysis of all patients treated for ARMs between 1999 and 2013 at our institution who underwent both spinal US (up to 5 months of life) and MRI. Sensibility and specificity have been calculated for US based on MRI results.
  
  
  RESULTS
  Of 244 patients treated for ARMs at our institution, 82 (34 females, 48 males) underwent both the imaging studies and have been included in this study. ARMs types were: anal stenosis (7), recto-vestibular fistula (19), recto-perineal fistula (3) and cloaca (5) in female and imperforate anus (7) recto-perineal fistula (14), recto-urethral fistula (22), recto-vesical fistula (5) in males. Forty-seven patients (57, 3 % of total, 18 females, 29 males) had some occult SD (tethered spinal cord, spinal lipoma, syringomyelia) at MRI. Only 7 (14, 8 %) patients of those with spinal anomalies at MRI had pathological US studies. In our population, sensibility and specificity of US for diagnosis of occult SD were, respectively, 14, 8 and 100 %.
  
  
  CONCLUSIONS
  Since it is well known that a screening test must have a high sensibility, our data suggest that spinal ultrasound is not suitable as a screening test for occult spinal dysraphism in patients with ARMs. Furthermore, we strongly advise against the use of US as a screening test for spinal dysraphism to prevent a false sense of security in physician and patients' families.
authors.affiliation: Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy, fscottoni@msn.com.
authors.forename: Federico
authors.initials: F
authors.lastname: Scottoni
authors.forename: Barbara Daniela
authors.initials: BD
authors.lastname: Iacobelli
authors.forename: Antonio Maria
authors.initials: AM
authors.lastname: Zaccara
authors.forename: Giorgia
authors.initials: G
authors.lastname: Totonelli
authors.forename: Antonio Maria Salvatore
authors.initials: AM
authors.lastname: Schingo
authors.forename: Pietro
authors.initials: P
authors.lastname: Bagolan
mesh_terms: D001003:Anal Canal / Q000002:abnormalities*; D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D012372:ROC Curve; D012007:Rectum / Q000002:abnormalities*; D012189:Retrospective Studies; D016135:Spinal Dysraphism / Q000000981:diagnostic imaging*; D013131:Spine / Q000000981:diagnostic imaging*; D014463:Ultrasonography