title: High resolution MRI for preoperative work-up of neonates with an anorectal malformation: a direct comparison with distal pressure colostography/fistulography.
abstract: OBJECTIVE
  To compare MRI and colostography/fistulography in neonates with anorectal malformations (ARM), using surgery as reference standard.
  
  
  METHODS
  Thirty-three neonates (22 boys) with ARM were included. All patients underwent both preoperative high-resolution MRI (without sedation or contrast instillation) and colostography/fistulography. The Krickenbeck classification was used to classify anorectal malformations, and the level of the rectal ending in relation to the levator muscle was evaluated.
  
  
  RESULTS
  Subjects included nine patients with a bulbar recto-urethral fistula, six with a prostatic recto-urethral fistula, five with a vestibular fistula, five with a cloacal malformation, four without fistula, one with a H-type fistula, one with anal stenosis, one with a rectoperineal fistula and one with a bladderneck fistula. MRI and colostography/fistulography predicted anatomy in 88 % (29/33) and 61 % (20/33) of cases, respectively (p = 0.012). The distal end of the rectal pouch was correctly predicted in 88 % (29/33) and 67 % (22/33) of cases, respectively (p = 0.065). The length of the common channel in cloacal malformation was predicted with MRI in all (100 %, 5/5) and in 80 % of cases (4/5) with colostography/fistulography. Two bowel perforations occurred during colostography/fistulography.
  
  
  CONCLUSIONS
  MRI provides the most accurate evaluation of ARM and should be considered a serious alternative to colostography/fistulography during preoperative work-up.
  
  
  CONCLUSIONS
  • High-resolution MRI is feasible without the use of sedation or anaesthesia. • MRI is more accurate than colostography/fistulography in visualising the type of ARM. • MRI is as reliable as colostography/fistulography in predicting the level of the rectal pouch. • Colostography/fistulography can be complicated by bowel perforation.
authors.affiliation: Department of Radiology, Erasmus MC, PO Box 2040, 's Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands. m.thomeer@erasmusmc.nl.
authors.forename: Maarten G
authors.initials: MG
authors.lastname: Thomeer
authors.affiliation: Department of Pediatric Radiology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Annick
authors.initials: A
authors.lastname: Devos
authors.affiliation: Department of Pediatric Radiology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Maarten
authors.initials: M
authors.lastname: Lequin
authors.affiliation: Department of Pediatric Radiology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Nanko
authors.initials: N
authors.lastname: De Graaf
authors.affiliation: Department of Pediatric Surgery, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Conny J H M
authors.initials: CJ
authors.lastname: Meeussen
authors.affiliation: Department of Pediatric Radiology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Morteza
authors.initials: M
authors.lastname: Meradji
authors.affiliation: Department of Pediatric Surgery, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Ivo
authors.initials: I
authors.lastname: De Blaauw
authors.affiliation: Department of Pediatric Surgery, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Cornelius E J
authors.initials: CE
authors.lastname: Sloots
mesh_terms: D001003:Anal Canal / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D011300:Preoperative Care; D011859:Radiography; D012007:Rectum / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D015203:Reproducibility of Results
keywords: Anorectal malformation; Colostography; Fistulography; MRI; Neonates