title: Comparison of dynamic magnetic resonance defaecography with rectal contrast and conventional defaecography for posterior pelvic floor compartment prolapse.
abstract: OBJECTIVE
  This study compared the diagnostic capabilities of dynamic magnetic resonance defaecography (D-MRI) with conventional defaecography (CD, reference standard) in patients with symptoms of prolapse of the posterior compartment of the pelvic floor.
  
  
  METHODS
  Forty-five consecutive patients underwent CD and D-MRI. Outcome measures were the presence or absence of rectocele, enterocele, intussusception, rectal prolapse and the descent of the anorectal junction on straining, measured in millimetres. Cohen's Kappa, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and the positive and negative likelihood ratio of D-MRI were compared with CD. Cohen's Kappa and Pearson's correlation coefficient were calculated and regression analysis was performed to determine inter-observer agreement.
  
  
  RESULTS
  Forty-one patients were available for analysis. D-MRI underreported rectocele formation with a difference in prevalence (CD 77.8% vs D-MRI 55.6%), mean protrusion (26.4 vs 22.7 mm, P = 0.039) and 11 false negative results, giving a low sensitivity of 0.62 and a NPV of 0.31. For the diagnosis of enterocele, D-MRI was inferior to CD, with five false negative results, giving a low sensitivity of 0.17 and high specificity (1.0) and PPV (1.0). Nine false positive intussusceptions were seen on D-MRI with only two missed.
  
  
  CONCLUSIONS
  The accuracy of D-MRI for diagnosing rectocele and enterocele is less than that of CD. D-MRI, however, appears superior to CD in identifying intussusception. D-MRI and CD are complementary imaging techniques in the evaluation of patients with symptoms of prolapse of the posterior compartment.
authors.affiliation: Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands.|Institute of Technical Medicine, Twente University, Enschede, The Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: van Iersel
authors.affiliation: Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands.
authors.forename: H A
authors.initials: HA
authors.lastname: Formijne Jonkers
authors.affiliation: Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands.
authors.forename: P M
authors.initials: PM
authors.lastname: Verheijen
authors.affiliation: Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands.|Institute of Technical Medicine, Twente University, Enschede, The Netherlands.
authors.forename: I A M J
authors.initials: IA
authors.lastname: Broeders
authors.affiliation: Department of Radiology, Meander Medical Centre, Amersfoort, The Netherlands.
authors.forename: B G F
authors.initials: BG
authors.lastname: Heggelman
authors.affiliation: Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands.
authors.forename: V
authors.initials: V
authors.lastname: Sreetharan
authors.affiliation: Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.|MIRA, Twente University, Enschede, The Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: Fütterer
authors.affiliation: Department of Radiology, Meander Medical Centre, Amersfoort, The Netherlands.
authors.forename: I
authors.initials: I
authors.lastname: Somers
authors.affiliation: Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: van der Leest
authors.affiliation: Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands.
authors.forename: E C J
authors.initials: EC
authors.lastname: Consten
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D019841:Defecography / Q000379:methods*; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D005260:Female; D006547:Hernia / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007443:Intussusception / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D016013:Likelihood Functions; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D059952:Pelvic Floor Disorders / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D056887:Pelvic Organ Prolapse / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011237:Predictive Value of Tests; D020047:Rectocele / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D012007:Rectum / Q000000981:diagnostic imaging; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric
chemical_list: D003287:Contrast Media
keywords: Dynamic MR defaecography; conventional defaecography; enterocele; intussusception; rectal prolapse; rectocele