MRI defecography of the ileal pouch-anal anastomosis—contributes little to the understanding of functional outcome
| Autor: | Arne Engebreth Færden, N. Bakka, Anne Negård, Tom Øresland, Marie Louise Sunde, Jonn Terje Geitung |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Anal Canal Colonic Pouches Anastomosis Pelvis Young Adult 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Defecography Aged Inflammation medicine.diagnostic_test business.industry Anastomosis Surgical Gastroenterology Pouchitis Middle Aged Hepatology medicine.disease Magnetic Resonance Imaging Ulcerative colitis Endoscopy stomatognathic diseases Treatment Outcome 030220 oncology & carcinogenesis Dynamic contrast-enhanced MRI Female 030211 gastroenterology & hepatology Radiology Pouch business |
| Zdroj: | International Journal of Colorectal Disease. 33:609-617 |
| ISSN: | 1432-1262 0179-1958 |
| DOI: | 10.1007/s00384-018-3011-0 |
| Popis: | Variability in functional outcome after ileal pouch-anal anastomosis (IPAA) is to a large extent unexplained. The aim of this study was to use MRI to evaluate the morphology, emptying pattern and other pathology that may explain differences in functional outcome between well-functioning and poorly functioning pouch patients. A secondary aim was to establish a reference of normal MRI findings in pelvic pouch patients. From a previous study, the best and worst functioning patients undergoing IPAA surgery between 2000 and 2013 had been identified and examined with manovolumetric tests (N = 47). The patients were invited to do a pelvic MRI investigating pouch morphology and emptying patterns, followed by a pouch endoscopy. Forty-three patients underwent MRI examination. We found no significant morphological or dynamic differences between the well-functioning and poorly functioning pouch patients. There was no correlation between urge volume and the volume of the bony pelvis, and no correlation between emptying difficulties or leakage and dynamic MRI findings. Morphological MRI signs of inflammation were present in the majority of patients and were not correlated to histological signs of inflammation. Of the radiological signs of inflammation, only pouch wall thickness correlated to endoscopic pouchitis disease activity index scores. It seems MRI does not increase the understanding of factors contributing to functional outcome after ileal pouch-anal anastomosis. Unless there is a clinical suspicion of perianal/peripouch disease or pelvic sepsis, MRI does not add value as a diagnostic tool for pelvic pouch patients. Endoscopy remains the golden standard for diagnosing pouch inflammation. |
| Databáze: | OpenAIRE |
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