Low muscle volume of the anal sphincter complex:A novel prognostic factor in children with anorectal malformations?
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In brief
In brief
MRI-based volumetric analysis of the anal sphincter complex in 76 infants demonstrates that children with anorectal malformations have significantly reduced muscle volume compared to controls, with the lowest volumes observed in cases with unfavorable prognosis for continence. This feasibility study establishes weight-dependent reference data and suggests ASC volume may serve as a novel prognostic marker for functional outcomes in ARM patients.
Written by the GCMD Library team from the article.
Background/Purpose
The anal sphincter complex (ASC) plays a key-role in continence and is often dysfunctional in infants born with anorectal malformations (ARM). The ASC is well depicted by magnetic resonance (MR) imaging but volumetric reference data are lacking in infants. Thus, we tested the feasibility of MR-based ASC volumetry, collected reference data, and compared them with cases of favourable prognosis and unfavourable prognosis (as defined by the type of ARM).
Methods
We determined ASC volume on T2-weighted MR-images of seventy-six infants (ARM n = 33; controls n = 43) by manual segmentation. Inter-operator agreement was assessed by intraclass-correlation coefficient. Linear regression was used to establish weight-dependent reference data. Observed-to-expected ASC volumes of patients with unfavourable and favourable prognosis were compared (unpaired t-test).
Results
ASC volumetry was feasible in all cases. Patients with ARM had low ‘observed-to-expected' ASC volume (-18.1%; p = 0.006). ‘Observed-to-expected' ASC volume differed significantly between patients with favourable and unfavourable prognosis (p < 0.001).
Conclusion
We confirmed the feasibility of MRI-based ASC volumetry and provided initial reference data for infants. Although ASC volumes were lowest in infants with ARM of unfavourable prognosis for fecal continence, the value of ASC volume as prognostic parameter remains to be determined.