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OBJECTIVES: To evaluate the agreement between three-dimensional endoanal ultrasound (3D- EAUS) and four-dimensional transperineal ultrasound (4D-TPUS) in measuring anal sphincter defect angle. METHODS: This was a secondary analysis of the PERINEAL study in women with wound infections. At each review, both 3D EAUS and 4D TPUS (at rest and on maximal pelvic floor muscle contraction (PFMC)) were performed. Kappa coefficient (k), intra-class correlation coefficients (ICC) and standard errors of measurement (SEM) were calculated. The largest angle size of a defect at the same sphincter level was analyzed. A defect was deemed significant if it was >30 degrees. RESULTS: 250 EAUS and 250 TPUS were performed in the same patients at each time point. An external anal sphincter (EAS) defect was found in 55 (22.0%) and 47 (18.8%) images on EAUS and TPUS respectively. An internal anal sphincter (IAS) defect was found in 26 images (10.4%) on both modalities. There was excellent agreement (k=0.87) with diagnosing EAS defects and perfect agreement (k=1.00) with diagnosing IAS defects. With TPUS at rest, there was poor and moderate agreement with EAS defect size and IAS defect size (SEM of ±16.10 and ±27.90 ) respectively. With TPUS performed during maximal PFMC, there was poor and moderate agreement with EAS defect size and IAS defect size (SEM of ±16.50 and ±26.40 ) respectively. Based on the SEMs, if the diagnostic cut off of 300 was used, incorrect diagnosis of a significant EAS defect could occur in approximately 9-27% of women. Incorrect diagnosis of a significant IAS defect could occur in approximately 7-15% of women. CONCLUSIONS: This is the first study to directly compare EAUS and TPUS angle measurements. A cut-off angle of 30 degrees should not be used for TPUS examination in the diagnosis of a residual anal sphincter defect. Further research is required to determine the cut off-angle for TPUS. This article is protected by copyright. All rights reserved. |
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