Constipation MRI: Difference between revisions
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==Overview== | ==Overview== | ||
Different [[MRI]] modalities may be helpful in the [[diagnosis]] of constipation underlying [[diseases]]. Four types of [[MRI]] which are used for diagnosing constipation are conventional [[pelvic]] [[MRI]], dynamic [[MRI]] (MR defecography), endoanal [[MRI]], and [[fluoroscopic]] [[MRI]]. [[Pelvic]] [[MRI]] mostly reveals the general structure and anatomy of [[pelvic]] organs. Findings on MR defecography suggestive of constipation include various types of [[rectal prolapse]] ([[mucosal]] or full-thickness), disorders of [[pelvic floor muscles]] movements, very acute [[anorectal]] angle, and Increased [[perineal]] descent degree during [[rectal]] evacuation. The major findings on [[Endorectal coil magnetic resonance imaging|endoanal MRI]] are thinning of [[Anal sphincter muscles|sphincter muscles]], disruption of [[Anal sphincter muscles|sphincter muscles]], and changes in the anorectal angle. [[Magnetic resonance imaging|MRI]] [[fluoroscopy]] is a real time modality that evaluates the [[pelvic floor]] and [[viscera]] during [[defecation]], [[valsalva maneuver]], and evacuation process. | |||
==MRI== | ==MRI== | ||
* Different [[MRI]] modalities may be helpful in the [[diagnosis]] of underlying [[diseases]] causing constipation. | |||
* Four types of [[MRI]] which are used for diagnosing constipation are conventional [[pelvic]] [[MRI]], dynamic [[MRI]] (MR defecography), endoanal [[MRI]], and [[fluoroscopic]] [[MRI]]. | |||
=== Pelvic MRI === | |||
* [[Pelvic]] [[MRI]] mostly reveals the general structure and anatomy of [[pelvic]] organs. | |||
* [[Pelvic]] [[MRI]] findings suggestive of constipation include:<ref name="pmid21382584">{{cite journal| author=Rao SS, Meduri K| title=What is necessary to diagnose constipation? | journal=Best Pract Res Clin Gastroenterol | year= 2011 | volume= 25 | issue= 1 | pages= 127-40 | pmid=21382584 | doi=10.1016/j.bpg.2010.11.001 | pmc=3063397 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21382584 }}</ref> | |||
** Changes in the [[anorectal]] angle | |||
**[[Perineal]] descent degree | |||
**[[Pelvic]] organs [[prolapse]] | |||
***[[Cystocele|'''Cystocele''']]: [[Bladder]] location more than 1 cm below the [[Pubococcygeus muscle|pubococcygeal]] line | |||
***[[Uterine prolapse|'''Uterine prolapse''']]: [[Uterine]] descent more than 3 cm below the [[Pubococcygeus muscle|pubococcygeal]] line along with [[caudal]] angulation of the [[Levator ani muscle|levator muscle]] | |||
***[[Rectocele|'''Rectocele''']]: [[Rectum]] anterior bulge more than 2 cm beyond the normal location of anterior rectal wall | |||
***[[Enterocele|'''Enterocele''']]: [[Small intestinal]] loops in the pouch of peritoneocele ([[peritoneal]] fat or fluid crossing [[Rectovaginal fascia|rectovaginal septum]]) | |||
=== Dynamic MRI (MR defecography) === | |||
{| align="right" | |||
|{{#ev:youtube|t_C5v9i6ALc|600}} | |||
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*Dynamic [[pelvic]] [[MRI]] (MR defecography) may be helpful in the [[diagnosis]] of constipation.<ref name="pmid16200243">{{cite journal |vauthors=Bolog N, Weishaupt D |title=Dynamic MR imaging of outlet obstruction |journal=Rom J Gastroenterol |volume=14 |issue=3 |pages=293–302 |year=2005 |pmid=16200243 |doi= |url=}}</ref> | |||
*Dynamic [[MRI]] is better to be obtained in the sitting position, rather than [[supine position]].<ref name="pmid11997560">{{cite journal |vauthors=Bertschinger KM, Hetzer FH, Roos JE, Treiber K, Marincek B, Hilfiker PR |title=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 |journal=Radiology |volume=223 |issue=2 |pages=501–8 |year=2002 |pmid=11997560 |doi=10.1148/radiol.2232010665 |url=}}</ref> | |||
*Findings on MR defecography suggestive of constipation include:<ref name="pmid12591061">{{cite journal |vauthors=Fletcher JG, Busse RF, Riederer SJ, Hough D, Gluecker T, Harper CM, Bharucha AE |title=Magnetic resonance imaging of anatomic and dynamic defects of the pelvic floor in defecatory disorders |journal=Am. J. Gastroenterol. |volume=98 |issue=2 |pages=399–411 |year=2003 |pmid=12591061 |doi=10.1111/j.1572-0241.2003.07235.x |url=}}</ref> | |||
**Differentiate various types of [[rectal prolapse]] ([[mucosal]] or full-thickness) | |||
**Disorders of [[pelvic floor muscles]] movements | |||
**Very acute [[anorectal]] angle reflects [[puborectalis muscle]] paradoxical contraction, which is called dyssynergia | |||
**Increased [[perineal]] descent degree during [[rectal]] evacuation can be suggestive of:<ref name="pmid15887104">{{cite journal |vauthors=Bharucha AE, Fletcher JG, Seide B, Riederer SJ, Zinsmeister AR |title=Phenotypic variation in functional disorders of defecation |journal=Gastroenterology |volume=128 |issue=5 |pages=1199–210 |year=2005 |pmid=15887104 |doi= |url=}}</ref> | |||
***Hypertensive [[anal sphincter]] | |||
***Normal [[rectal]] balloon expulsion test | |||
***[[Rectocele]] | |||
*Finally, lack of valid standardization and also expensive prices are the major limitation ahead of MR defecography. | |||
=== Endoanal MRI === | |||
*[[Endorectal coil magnetic resonance imaging|Endoanal MRI evaluation]] is done through inserting a disposable endorectal colon coil into the patient's [[anus]]. | |||
*[[Anal sphincter|Anal sphincters]] function and arrangement are studied using [[Endorectal coil magnetic resonance imaging|endoanal MRI]]. | |||
*The major findings on [[Endorectal coil magnetic resonance imaging|endoanal MRI]] are:<ref name="pmid12591061" /> | |||
**Thinning of [[Anal sphincter muscles|sphincter muscles]] | |||
**Disruption of [[Anal sphincter muscles|sphincter muscles]] | |||
**Changes in the anorectal angle | |||
**[[Puborectalis muscle]] [[atrophy]] | |||
{| align="right" | |||
|{{#ev:youtube|vE3puK5eYfY|600}} | |||
|} | |||
=== MRI fluoroscopy === | |||
*[[Magnetic resonance imaging|MRI]] [[fluoroscopy]] is a real time modality that evaluates the [[pelvic floor]] and [[viscera]] during [[defecation]], [[valsalva maneuver]], and evacuation process.<ref name="pmid16200243" /> | |||
*Abnormal [[perineal]] descent or [[anorectal]] angle during [[defecation]] in [[MRI]] [[fluoroscopy]] may reflect dyssynergic [[defecation]]. | |||
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==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
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[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category: | [[Category:Medicine]] | ||
[[Category:Up-To-Date]] | |||
[[Category:Emergency medicine]] | |||
[[Category:Radiology]] | |||
Latest revision as of 21:07, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]
Overview
Different MRI modalities may be helpful in the diagnosis of constipation underlying diseases. Four types of MRI which are used for diagnosing constipation are conventional pelvic MRI, dynamic MRI (MR defecography), endoanal MRI, and fluoroscopic MRI. Pelvic MRI mostly reveals the general structure and anatomy of pelvic organs. Findings on MR defecography suggestive of constipation include various types of rectal prolapse (mucosal or full-thickness), disorders of pelvic floor muscles movements, very acute anorectal angle, and Increased perineal descent degree during rectal evacuation. The major findings on endoanal MRI are thinning of sphincter muscles, disruption of sphincter muscles, and changes in the anorectal angle. MRI fluoroscopy is a real time modality that evaluates the pelvic floor and viscera during defecation, valsalva maneuver, and evacuation process.
MRI
- Different MRI modalities may be helpful in the diagnosis of underlying diseases causing constipation.
- Four types of MRI which are used for diagnosing constipation are conventional pelvic MRI, dynamic MRI (MR defecography), endoanal MRI, and fluoroscopic MRI.
Pelvic MRI
- Pelvic MRI mostly reveals the general structure and anatomy of pelvic organs.
- Pelvic MRI findings suggestive of constipation include:[1]
- Changes in the anorectal angle
- Perineal descent degree
- Pelvic organs prolapse
- Cystocele: Bladder location more than 1 cm below the pubococcygeal line
- Uterine prolapse: Uterine descent more than 3 cm below the pubococcygeal line along with caudal angulation of the levator muscle
- Rectocele: Rectum anterior bulge more than 2 cm beyond the normal location of anterior rectal wall
- Enterocele: Small intestinal loops in the pouch of peritoneocele (peritoneal fat or fluid crossing rectovaginal septum)
Dynamic MRI (MR defecography)
| t_C5v9i6ALc|600}} |
- Dynamic pelvic MRI (MR defecography) may be helpful in the diagnosis of constipation.[2]
- Dynamic MRI is better to be obtained in the sitting position, rather than supine position.[3]
- Findings on MR defecography suggestive of constipation include:[4]
- Differentiate various types of rectal prolapse (mucosal or full-thickness)
- Disorders of pelvic floor muscles movements
- Very acute anorectal angle reflects puborectalis muscle paradoxical contraction, which is called dyssynergia
- Increased perineal descent degree during rectal evacuation can be suggestive of:[5]
- Hypertensive anal sphincter
- Normal rectal balloon expulsion test
- Rectocele
- Finally, lack of valid standardization and also expensive prices are the major limitation ahead of MR defecography.
Endoanal MRI
- Endoanal MRI evaluation is done through inserting a disposable endorectal colon coil into the patient's anus.
- Anal sphincters function and arrangement are studied using endoanal MRI.
- The major findings on endoanal MRI are:[4]
- Thinning of sphincter muscles
- Disruption of sphincter muscles
- Changes in the anorectal angle
- Puborectalis muscle atrophy
| vE3puK5eYfY|600}} |
MRI fluoroscopy
- MRI fluoroscopy is a real time modality that evaluates the pelvic floor and viscera during defecation, valsalva maneuver, and evacuation process.[2]
- Abnormal perineal descent or anorectal angle during defecation in MRI fluoroscopy may reflect dyssynergic defecation.
References
- ↑ Rao SS, Meduri K (2011). "What is necessary to diagnose constipation?". Best Pract Res Clin Gastroenterol. 25 (1): 127–40. doi:10.1016/j.bpg.2010.11.001. PMC 3063397. PMID 21382584.
- ↑ 2.0 2.1 Bolog N, Weishaupt D (2005). "Dynamic MR imaging of outlet obstruction". Rom J Gastroenterol. 14 (3): 293–302. PMID 16200243.
- ↑ Bertschinger KM, Hetzer FH, Roos JE, Treiber K, Marincek B, Hilfiker PR (2002). "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. 223 (2): 501–8. doi:10.1148/radiol.2232010665. PMID 11997560.
- ↑ 4.0 4.1 Fletcher JG, Busse RF, Riederer SJ, Hough D, Gluecker T, Harper CM, Bharucha AE (2003). "Magnetic resonance imaging of anatomic and dynamic defects of the pelvic floor in defecatory disorders". Am. J. Gastroenterol. 98 (2): 399–411. doi:10.1111/j.1572-0241.2003.07235.x. PMID 12591061.
- ↑ Bharucha AE, Fletcher JG, Seide B, Riederer SJ, Zinsmeister AR (2005). "Phenotypic variation in functional disorders of defecation". Gastroenterology. 128 (5): 1199–210. PMID 15887104.