MR-Defäkografie bei obstruktiven Defäkationsstörungen

Zusammenfassung

Getragen durch den demografischen Wandel nehmen obstruktive Defäkationsstörungen stetig zu. Morphologische und funktionelle Ursachen spielen ineinander und tragen zur Komplexität dieser Erkrankung bei, was sich darin widerspiegelt, dass oft mehrere Kompartimente des Beckenbodens betroffen sind. Durch Anwendung der MR-Defäkografie können simultan detaillierte Informationen über Morphologie und Funktion der Kontinenzorgane gewonnen werden. Damit unterstützt das Verfahren als integraler Baustein des diagnostischen Workups maßgeblich die präoperative Abklärung des Anorektums. Verglichen mit der konventionellen Defäkografie, kann als Nachteil der Methode die Aufnahmetechnik im Liegen interpretiert werden, was in Einzelfällen eine suffiziente Entleerung der Rektumampulle erschwert oder gar verhindert. Dieser inhärente Nachteil wird jedoch durch die hohe anatomische Detailauflösung, die multiplanare Darstellung, die einfache Durchführung und nicht zuletzt das Fehlen einer Strahlenexposition aufgehoben. Konsekutiv hat sich die MR-Defäkografie als ein Verfahren der ersten Wahl zur Klärung von anorektalen Entleerungsstörungen in der klinischen Routine etabliert.

Abstract

As a consequence of demographic changes, outlet obstruction represents an increasingly common disease. The presence and ample interactions of morphological and functional pathologies contribute to the complexity of pelvic floor dysfunction. Additionally, multiple compartments of the pelvic floor are frequently affected. MR defaecography allows for the simultaneous and detailed assessment of morphological as well as functional changes of the pelvic floor. Hence, this approach constitutes an integral part of the diagnostic work-up and preoperative evaluation of the anorectum. The supine patient position can be regarded as a drawback compared to conventional defaecography, as sufficient emptying of the rectum can be impaired or even rendered impossible in individual cases. This inherent disadvantage is, however, compensated by the high anatomic resolution, the possibility of multiplanar imaging, easy execution and especially the lack of ionising radiation. Consequently, MR defaecography is considered the method of choice for the routine evaluation of functional anorectal disorders.

Schlüsselwörter

Beckenboden - obstruktive Defäkationsstörung - MR-Defäkografie

Key words

pelvic floor - obstructive defaecation disorders - MR defaecography

• Literatur

• 1 Olsen AL, Smith VJ, Bergstrom JO et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 1997; 89: 501-506
• 2 Rush CB, Entman SS. Pelvic organ prolapse and stress urinary incontinence. Med Clin North Am 1995; 79: 1473-1479
• 3 Weber AM, Abrams P, Brubaker L et al. The standardization of terminology for researchers in female pelvic floor disorders. Int Urogynecol J Pelvic Floor Dysfunct 2001; 12: 178-186
• 4 Kelvin FM, Hale DS, Maglinte DD et al. Female pelvic organ prolapse: diagnostic contribution of dynamic cystoproctography and comparison with physical examination. AJR 1999; 173: 31-37
• 5 Nygaard IE, Kreder KJ. Complication of colposuspension. Int Urogynecol J 1994; 5: 353-360
• 6 Martin DR, Salman K, Wilmot CC et al. MR imaging evaluation of the pelvic floor for the assessment of vaginal prolapse and urinary incontinence. Magn Reson Imaging Clin N Am 2006; 14: 523-535
• 7 Hetzer FH, Andreisek G, Tsagari C et al. MR defecography in patients with fecal incontinence: imaging findings and their effect on surgical management. Radiology 2006; 240: 449-457
• 8 Colaiacomo MC, Masselli G, Polettini E et al. Dynamic MR imaging of the pelvic floor: a pictorial review. Radiographics 2009;
• 9 Hecht EM, Lee VS, Tanpitukpongse TP et al. MRI of pelvic floor dysfunction: dynamic true fast imaging with steady-state precession versus HASTE. AJR 2008; 191: 352-358
• 10 Law YM, Fielding JR. MRI of pelvic floor dysfunction: review. AJR 2008; 191: 45-53
• 11 Silva WA, Kleeman S, Segal J et al. Effects of a full bladder and patient positioning on pelvic organ prolapse assessment. Obstet Gynecol 2004; 104: 37-41
• 12 Lienemann A, Fischer T. Functional imaging of the pelvic floor. Eur J Radiol 2003; 47: 117-122
• 13 Bertschinger KM, Hetzer FH, Roos JE et al. Dynamic MR imaging of the pelvic floor performed with patient sitting in an open-magnet unit versus with patient supine in a closed-magnet unit. Radiology 2002; 223: 501-508
• 14 Pilkington S, Nugent K, Brenner J et al. Barium proctography versus magnetic resonance proctography for pelvic floor disorders: a comparative study. Colorectal Dis 2012;
• 15 Maglinte DD, Bartram CI, Hale DA et al. Functional imaging of the pelvic floor. Radiology 2011; 258: 23-39
• 16 Boyadzhyan L, Raman SS, Raz S. Role of static and dynamic MR imaging in surgical pelvic floor dysfunction. Radiographics 2008; 28: 949-967
• 17 Goh V, Halligan S, Kaplan G et al. Dynamic MR imaging of the pelvic floor in asymptomatic subjects. AJR 2000; 174: 661-666
• 18 Healy JC, Halligan S, Reznek RH et al. Dynamic MR imaging compared with evacuation proctography when evaluating anorectal configuration and pelvic floor movement. AJR 1997; 169: 775-779
• 19 Madill S, Tang A, Pontbriand-Drolet S et al. Comparison of two methods for measuring the pubococcygeal line from sagittal-plane magnetic resonance imaging. Neurourol Urodyn 2011; 30: 1613-1619
• 20 El Sayed RF, El Mashed S, Farag A et al. Pelvic floor dysfunction: assessment with combined analysis of static and dynamic MR imaging findings. Radiology 2008; 248: 518-530
• 21 Fielding JR. Practical MR imaging of female pelvic floor weakness. Radiographics 2002; 22: 295-304
• 22 Macura KJ, Genadry RR. Female urinary incontinence: Pathophysiology, methods of evaluation and role of MR imaging. Abdom Imaging 2008; 33: 371-380
• 23 Healy JC, Halligan S, Reznek RH et al. Magnetic resonance imaging of the pelvic floor in patients with obstructed defecation. Br J Surg 1997; 84: 1555-1558
• 24 Mortele KJ, Fairhurst J. Dynamic MR defecography of the posterior compartment: indications, technique and MRI features. Eur J Radiol 2007; 61: 462-472
• 25 Comiter CV, Vasavada SP, Barbaric ZL et al. Grading pelvic prolapse and pelvic floor relaxation using dynamic magnetic resonance imaging. Urology 1999; 54: 454-457
• 26 Hoyte L, Schierlitz L, Zou K et al. Two- and 3-dimensional MRI comparison of levator ani structure, volume and integrity in women with stress incontinence and prolapse. Am J Obstet Gynecol 2001; 185: 11-19
• 27 Locke 3rd GR, Pemberton JH, Phillips SF. AGA technical review on constipation. American Gastroenterological Association. Gastroenterology 2000; 119: 1766-1778
• 28 Barbaric ZL, Marumoto AK, Raz S. Magnetic resonance imaging of the perineum and pelvic floor. Top Magn Reson Imaging 2001; 12: 83-92
• 29 Lienemann A, Anthuber C, Baron A et al. Diagnosing enteroceles using dynamic magnetic resonance imaging. Dis Colon Rectum 2000; 43: 205-212
• 30 Rodriguez LV, Raz S. Diagnostic imaging of pelvic floor dysfunction. Curr Opin Urol 2001; 11: 423-428
• 31 Raz S, Stothers L, Chopra A. Vaginal reconstructive Surgery for Incontinence and Prolapse. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ, eds. Campbellʼs Urology. 2nd ed. Philadelphia: Saunders; 1998: 1059-1094
• 32 Collinson R, Cunningham C, DʼCosta H et al. Rectal intussusception and unexplained faecal incontinence: findings of a proctographic study. Colorectal Dis 2009; 11: 77-83
• 33 Shorvon PJ, McHugh S, Diamant NE et al. Defecography in normal volunteers: results and implications. Gut 1989; 30: 1737-1749
• 34 Roos JE, Weishaupt D, Wildermuth S et al. Experience of 4 years with open MR defecography: pictorial review of anorectal anatomy and disease. Radiographics 2002; 22: 817-832
• 35 Dvorkin LS, Hetzer F, Scott SM et al. Open-magnet MR defecography compared with evacuation proctography in the diagnosis and management of patients with rectal intussusception. Colorectal Dis 2004; 6: 45-53
• 36 Tsiaoussis J, Chrysos E, Glynos M et al. Pathophysiology and treatment of anterior rectal mucosal prolapse syndrome. Br J Surg 1998; 85: 1699-1702
• 37 Halligan S, Malouf A, Bartram CI et al. Predictive value of impaired evacuation at proctography in diagnosing anismus. AJR 2001; 177: 633-636
• 38 Stoker J, Halligan S, Bartram C. Pelvic floor imaging. Radiology 2001; 218: 621-641
• 39 Kuijpers HC, Bleijenberg G. The spastic pelvic floor syndrome. A cause of constipation. Dis Colon Rectum 1985; 28: 669-672
• 40 Halligan S, Bartram CI, Park HJ et al. Proctographic features of anismus. Radiology 1995; 197: 679-682