By Mario Pescatori, Francisco Sérgio Pinheiro Regadas, Sthela Maria Murad Regadas, Andrew P. Zbar, Clive I. Bartram, Robert D. Madoff
The objective of this atlas, edited and authored through across the world revered specialists within the box, is to obviously and accurately current symptoms, innovations, obstacles, assets of error, and pitfalls of numerous imaging modalities. The textual content describes the considerable, fine quality pictures that convey the traditional anorectal anatomy in addition to the pathological visual appeal of the all-too-common large-bowel and pelvic ground sensible illnesses. using radiopaque markers in diagnosing colonic inertia; defecography, 3D US, and MRI in investigating obstructed defecation; 3D US and MRI in differentiating among benign and malignant anorectal neoplasms; CT and MRI in assessing pelviperineal anatomy and selecting pelvic tumors and inflammatory methods; and 2D-3D US in identifying applicable remedy for fecal incontinence are mentioned intensive. This atlas demonstrates the worth of a staff process among colorectal surgeons and radiologists for fixing complicated medical problems of the anorectum and PF.
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Extra info for Imaging Atlas of the Pelvic Floor and Anorectal Diseases
5). EAMRI has demonstrated accuracy in this evaluation, which has been validated both surgically and histologically [18, 22]. In the study by Briel and colleagues assessing comparative sphincter histology, EAMRI demonstrated accuracy in evaluating EAS atrophy in 93% (14/15) cases . The reproducibility of EAMRI for determining EAS atrophy is somewhat dependent upon experience; the reported interobserver agreement is moderate and the intraobserver agreement is moderate to very good . Endoanal Magnetic Resonance Imaging versus Endoanal Ultrasonography EAUS has limitations in identifying EAS atrophy, as already indicated.
In limited EAS atrophy, some intertwining fat is seen among the muscle so that a considerable amount of muscle mass can still be identified. Moderate atrophy represents an intermediate situation between these two extremes, providing a potential for semiquantitative atrophy assessment. Here, mild atrophy represents <50% thinning/replacement, with severe atrophy representing >50% thinning or total muscle replacement with fat. Although a comparison with the puborectalis muscle or levator plate can also be made to objectify atrophy, this can be relatively inaccurate, as these muscles may atrophy concomitantly as part of an overall pudendal neuropathy.
Intraobserver agreement ranged from fair to very good for both imaging techniques, reflecting specific familiarity of some radiologists with either modality. The findings for EAS atrophy were comparable where the techniques did not significantly differ in their ability to depict EAS atrophy, showing gener- 46 J. P. 72 (Fig. 5) . 8). 86). Overall, it would seem that given the limited availability of endoanal coils, external phased-array MRI could be a valid alternative for clinical use in demonstrating EAS defects and atrophy, provided that – given its moderate learning curve – there is sufficient experience available [14, 42, 56].
Imaging Atlas of the Pelvic Floor and Anorectal Diseases by Mario Pescatori, Francisco Sérgio Pinheiro Regadas, Sthela Maria Murad Regadas, Andrew P. Zbar, Clive I. Bartram, Robert D. Madoff