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External anal sphincter defects: Correlation between pre-operative anal endosonography and intraoperative findings
2B3
CLINICAL IMAGING VOL. 20, NO. 3
ABSTRACTS
HIGH RESOLUTION MAGNETIC RESONANCE IMAGING VIA AN ENDORECTAL COIL: RESULTS IN RECTAL TUMORS (In German) Pegios W, Vogl ThJ, Hiinerbein M, et al. (Humboldt-Universimt Berlin-Virchow Klinikum, Strahlen Klinik u. Poliklinik, Augustenburger Platz 1,D-13353 Berlin, Germany). Fortsch Rijntgenstr 1996;164:132-140. The purpose of this study was to assess the value of high-resolution magnetic resonance imaging (MRI) of the rectum using an endorectal coil. Ten volunteers and 31 patients with suspected rectal tumors were. examined. In 17 patients with rectal carcinoma, of which 15 subsequently underwent radical surg,ery, the preoperatively-obtained tumor stage was compared with the histological findings. In 12 patients with rectal adenoma (severe and medium graded epithelial dysplasias according to the World He&h Organization) who underwent endoscopy the results of the endorectal surface coil examination were compared with endoscopy and histology. In four patients with large rectal adenomas the surface coil was used before and as follow-up after endoscapic electro laser resection, and the absence of adenoma after therapy in the deeper layers of the rectal wall could be confirmed. The results obtained show that the visualization of the anatomical structures of the rectum and adjacent structures is improved by the use of the endorectal surface coil. The diagnosis of carcinoma and adenoma of the rectum and the documentation of the exact extension can be reached with high accuracy (85%). In conclusion, MRI with an endorectal surface coil may play an important role in the preoperative diagnosis of rectal carcinoma. This method is useful for primary diagnosis and followup of large rectal adenoma after endoscopic electro laser resection. Authors’
Summary
EXTERNAL ANAL SPHINCTER DEFECTS: CORRELATION BETWEEN PRE-OPERATIVE ANAL ENDOSONOGRAPHY AND INTRAOPERATIVE FINDINGS Roman0 G, Rotondano G, Esposito P, et al. (Via Belsito 19,I-80123 Napoli, Italy). Brit J Radio1
1996:69:6-g. In order to correlate operative findings with external anal sphincter (EAS) defects identified on anal endosonography (AES), 30 fecally incontinent patients
undergoing overlapping sphincteroplasty or total pelvic floor repair were investigated by AES before and after surgery. The endosonographic findings were correlated with the appearance of EAS at operation. Twenty-one out of 22 defects seen at surgery had been pre-operatively detected by AES (one false negative). Post-operatively the sphincteroplasty was clearly evident on AES. In three cases of failure it showed an extensive hypoechoic area and these patients underwent dynamic graciloplasty. Endosonography is the method of choice for pre-operative imaging of EAS, having an established role in identifying sphincter defects and correlating well with intraoperative findings. Post-operatively, it has the potential to identify breakdown of the previous repair, allowing prompt surgical intervention. Endosonography is helpful in planning the best type of operation following sphincter injury and is useful in auditing the results of surgery. Authors’
Summary
TECHNIQUE OF MR-GUIDED CORE BIOPSY OF ABDOMINAL MASSES USING AN OPEN LOWFIELD SCANNER: FEASIBILITY AND FIRST CLINICAL RESULTS (In German) Frahm C, Gehl H-B, Weiss H-D, Rossberg W-A (Medizinische Universitat Lubeck, Institut f. Radiologie, Ratzeburger Allee 160, D-23538 Liibeck, Germany). Fortschr Rontgenstr
1996:164:62-67. Due to high soft-tissue contrast and multiplanar imaging capabilities magnetic resonance imaging (MRI) is an interesting modality to perform image-guided biopsies. We checked on the feasibility of MR-guided core biopsies of abdominal masses with an open lowfield scanner (0.2 Tesla; vertical field axis). Nine patients underwent MR-guided biopsies of abdominal target lesions (six focal liver lesions, two adrenal masses, one pelvic mass). Different MR-compatible core biopsy instruments were used (needle diameters 14 G-18 G).MR scans during the procedures were obtained applying T,-weighted gradient echo sequences suitable for breath-hold imaging. In each case, needle guidance was reliable, so that the biopsy instrument could be positioned correctly. Multiplanar imaging capabilities enabled even angled approaches to upper abdominal masses to be realized safely. The combination of magnet design and table design offered suitable access to the patient. In conclusion, using an open low-field scan-
CLINICAL IMAGING VOL. 20, NO. 3
ABSTRACTS
HIGH RESOLUTION MAGNETIC RESONANCE IMAGING VIA AN ENDORECTAL COIL: RESULTS IN RECTAL TUMORS (In German) Pegios W, Vogl ThJ, Hiinerbein M, et al. (Humboldt-Universimt Berlin-Virchow Klinikum, Strahlen Klinik u. Poliklinik, Augustenburger Platz 1,D-13353 Berlin, Germany). Fortsch Rijntgenstr 1996;164:132-140. The purpose of this study was to assess the value of high-resolution magnetic resonance imaging (MRI) of the rectum using an endorectal coil. Ten volunteers and 31 patients with suspected rectal tumors were. examined. In 17 patients with rectal carcinoma, of which 15 subsequently underwent radical surg,ery, the preoperatively-obtained tumor stage was compared with the histological findings. In 12 patients with rectal adenoma (severe and medium graded epithelial dysplasias according to the World He&h Organization) who underwent endoscopy the results of the endorectal surface coil examination were compared with endoscopy and histology. In four patients with large rectal adenomas the surface coil was used before and as follow-up after endoscapic electro laser resection, and the absence of adenoma after therapy in the deeper layers of the rectal wall could be confirmed. The results obtained show that the visualization of the anatomical structures of the rectum and adjacent structures is improved by the use of the endorectal surface coil. The diagnosis of carcinoma and adenoma of the rectum and the documentation of the exact extension can be reached with high accuracy (85%). In conclusion, MRI with an endorectal surface coil may play an important role in the preoperative diagnosis of rectal carcinoma. This method is useful for primary diagnosis and followup of large rectal adenoma after endoscopic electro laser resection. Authors’
Summary
EXTERNAL ANAL SPHINCTER DEFECTS: CORRELATION BETWEEN PRE-OPERATIVE ANAL ENDOSONOGRAPHY AND INTRAOPERATIVE FINDINGS Roman0 G, Rotondano G, Esposito P, et al. (Via Belsito 19,I-80123 Napoli, Italy). Brit J Radio1
1996:69:6-g. In order to correlate operative findings with external anal sphincter (EAS) defects identified on anal endosonography (AES), 30 fecally incontinent patients
undergoing overlapping sphincteroplasty or total pelvic floor repair were investigated by AES before and after surgery. The endosonographic findings were correlated with the appearance of EAS at operation. Twenty-one out of 22 defects seen at surgery had been pre-operatively detected by AES (one false negative). Post-operatively the sphincteroplasty was clearly evident on AES. In three cases of failure it showed an extensive hypoechoic area and these patients underwent dynamic graciloplasty. Endosonography is the method of choice for pre-operative imaging of EAS, having an established role in identifying sphincter defects and correlating well with intraoperative findings. Post-operatively, it has the potential to identify breakdown of the previous repair, allowing prompt surgical intervention. Endosonography is helpful in planning the best type of operation following sphincter injury and is useful in auditing the results of surgery. Authors’
Summary
TECHNIQUE OF MR-GUIDED CORE BIOPSY OF ABDOMINAL MASSES USING AN OPEN LOWFIELD SCANNER: FEASIBILITY AND FIRST CLINICAL RESULTS (In German) Frahm C, Gehl H-B, Weiss H-D, Rossberg W-A (Medizinische Universitat Lubeck, Institut f. Radiologie, Ratzeburger Allee 160, D-23538 Liibeck, Germany). Fortschr Rontgenstr
1996:164:62-67. Due to high soft-tissue contrast and multiplanar imaging capabilities magnetic resonance imaging (MRI) is an interesting modality to perform image-guided biopsies. We checked on the feasibility of MR-guided core biopsies of abdominal masses with an open lowfield scanner (0.2 Tesla; vertical field axis). Nine patients underwent MR-guided biopsies of abdominal target lesions (six focal liver lesions, two adrenal masses, one pelvic mass). Different MR-compatible core biopsy instruments were used (needle diameters 14 G-18 G).MR scans during the procedures were obtained applying T,-weighted gradient echo sequences suitable for breath-hold imaging. In each case, needle guidance was reliable, so that the biopsy instrument could be positioned correctly. Multiplanar imaging capabilities enabled even angled approaches to upper abdominal masses to be realized safely. The combination of magnet design and table design offered suitable access to the patient. In conclusion, using an open low-field scan-