title: Three-dimensional high-resolution anorectal manometry: does it allow automated analysis of sphincter defects?
abstract: OBJECTIVE
  Anorectal manometry is the most common test used to explore anorectal disorders. The recent three-dimensional high-resolution anorectal manometry (3D-HRAM) technique appears to be able to provide new topographic information. Our objective was to develop an automated analysis of 3D-HRAM images to diagnose anal sphincter defects and compare the results with those of endoanal ultrasonography (EUS), which is considered to be the gold standard.
  
  
  METHODS
  All patients being tested in our department for faecal incontinence or dyschezia by 3D-HRAM and EUS were eligible for the study. 3D-HRAM was used to record resting and squeeze pressure, reflecting internal and external anal sphincter function, respectively. A software platform was designed to automatically analyse the 3D-HRAM images and calculate a diagnostic score for any anal sphincter defect compared with EUS.
  
  
  RESULTS
  A total of 206 (91% female) patients of mean age of 54 years were included in the study. A sphincter defect was diagnosed by EUS in 130 (63%). The diagnostic scores from the 3D-HRAM automated analysis for an internal anal sphincter defect showed a sensitivity of 65% and a specificity of 65%. For an external anal sphincter defect, the sensitivity was 43% and the specificity 87%.
  
  
  CONCLUSIONS
  Our study developed a method based on 3D-HRAM to automatically diagnose sphincter defects, allowing a systematic and comprehensive analysis of the test recordings. Compared with EUS, the 3D-HRAM image analysis procedure revealed poor sensitivity and specificity.
authors.affiliation: Service de Gastroentérologie, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France.
authors.forename: A
authors.initials: A
authors.lastname: Benezech
authors.affiliation: Centre d'Investigation Clinique 1409, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France.
authors.forename: M
authors.initials: M
authors.lastname: Behr
authors.affiliation: Service de Gastroentérologie, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France.|Plateforme d'Interface Clinique, CRN2M CNRS UMR 7286, Aix-Marseille Université, Marseille, France.
authors.forename: M
authors.initials: M
authors.lastname: Bouvier
authors.affiliation: Service de Gastroentérologie, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France.|Plateforme d'Interface Clinique, CRN2M CNRS UMR 7286, Aix-Marseille Université, Marseille, France.
authors.forename: J-C
authors.initials: JC
authors.lastname: Grimaud
authors.affiliation: Service de Gastroentérologie, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France.|Plateforme d'Interface Clinique, CRN2M CNRS UMR 7286, Aix-Marseille Université, Marseille, France.
authors.forename: V
authors.initials: V
authors.lastname: Vitton
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001331:Automation / Q000295:instrumentation*; D015331:Cohort Studies; D003248:Constipation / Q000175:diagnosis; D019160:Endosonography / Q000379:methods; D005242:Fecal Incontinence / Q000175:diagnosis*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012984:Software
keywords: Anorectal function; anal sphincter defect; endoanal ultrasonography; three-dimensional high-resolution anorectal manometry