High resolution MRI for preoperative work-up of neonates with an anorectal malformation: a direct comparison with distal pressure colostography/fistulography

Maarten Thomeer, Annick Devos, MH Lequin, Nanko Graaf, C Meeussen, Morteza Meradji, Ivo Blaauw, C Sloots

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Abstract

To compare MRI and colostography/fistulography in neonates with anorectal malformations (ARM), using surgery as reference standard. 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. 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. MRI provides the most accurate evaluation of ARM and should be considered a serious alternative to colostography/fistulography during preoperative work-up. aEuro cent High-resolution MRI is feasible without the use of sedation or anaesthesia. aEuro cent MRI is more accurate than colostography/fistulography in visualising the type of ARM. aEuro cent MRI is as reliable as colostography/fistulography in predicting the level of the rectal pouch. aEuro cent Colostography/fistulography can be complicated by bowel perforation.
Original languageUndefined/Unknown
Pages (from-to)3472-3479
Number of pages8
JournalEuropean Radiology
Volume25
Issue number12
DOIs
Publication statusPublished - 2015

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