Postpartum two- and three-dimensional ultrasound evaluation of anal sphincter complex in women with obstetric anal sphincter injury

Autor: Montserrat Palacio, J. Cassadó, Cristina Ros, Magdalena Wozniak, Nuria Elias, E. Martínez-Franco, Giulio Aniello Santoro, Andrzej Paweł Wieczorek, Montserrat Espuña-Pons, Marta López
Rok vydání: 2017
Předmět:
Adult
medicine.medical_specialty
endoanal ultrasound
Urology
Anal Canal
Sensitivity and Specificity
03 medical and health sciences
Imaging
Three-Dimensional
0302 clinical medicine
Endoanal ultrasound
obstetric injuries
medicine
Humans
Fecal incontinence
Radiology
Nuclear Medicine and imaging
030212 general & internal medicine
Observer Variation
Three dimensional ultrasound
030219 obstetrics & reproductive medicine
Radiological and Ultrasound Technology
business.industry
Postpartum Period
Ultrasound
Obstetrics and Gynecology
transperineal ultrasound
General Medicine
Gold standard (test)
Anal canal
Delivery
Obstetric
endovaginal ultrasound
fecal incontinence
medicine.anatomical_structure
Reproductive Medicine
Female
anal sphincter
medicine.symptom
three-dimensional ultrasound
Anal sphincter
business
Nuclear medicine
Postpartum period
Zdroj: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu
instname
ULTRASOUND IN OBSTETRICS & GYNECOLOGY
r-FSJD: Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu
Fundació Sant Joan de Déu
ISSN: 0960-7692
1469-0705
DOI: 10.1002/uog.15924
Popis: OBJECTIVE: To compare the sensitivity and specificity of two- (2D) and three- (3D) dimensional transperineal ultrasound (TPUS) and 3D endovaginal ultrasound (EVUS) with the gold standard 3D endoanal ultrasound (EAUS) in detecting residual defects after primary repair of obstetric anal sphincter injuries (OASIS). METHODS: External (EAS) and internal (IAS) anal sphincters were evaluated by the four ultrasound modalities in women with repaired OASIS. 2D-TPUS was evaluated in real-time, whereas 3D-TPUS, 3D-EVUS and 3D-EAUS volumes were evaluated offline by six blinded readers. The presence/absence of any tear in EAS or IAS was recorded and defects were scored according to the Starck system. Sensitivity, specificity and predictive values were calculated, using 3D-EAUS as reference standard. Inter- and intraobserver analyses were performed for all 3D imaging modalities. Association between patients' symptoms (Wexner score) and ultrasound findings (Starck score) was calculated. RESULTS: Images from 55 patients were analyzed. Compared with findings on 3D-EAUS, the agreement for EAS evaluation was poor for 3D-EVUS (? = 0.01), fair for 2D-TPUS (? = 0.30) and good for 3D-TPUS (? = 0.73). The agreement for IAS evaluation was moderate for both 3D-EVUS (? = 0.41) and 2D-TPUS (? = 0.52) and good for 3D-TPUS (? = 0.66). Good intraobserver (3D-EAUS, ? = 0.73; 3D-TPUS, ? = 0.78) and interobserver (3D-EAUS, ? = 0.68; 3D-TPUS, ? = 0.60) agreement was reported. Significant association between Starck and Wexner scores was found only for 3D-EAUS (Spearman's rho = 0.277, P = 0.04). CONCLUSIONS: 2D-TPUS and 3D-EVUS are not accurate modalities for the assessment of anal sphincters after repair of OASIS. 3D-TPUS shows good agreement with the gold standard 3D-EAUS and a high sensitivity in detecting residual defects. It, thus, has potential as a screening tool after primary repair of OASIS. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
Databáze: OpenAIRE
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