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Three-dimensional anal endosonography in depicting anal-canal anatomy

Rappresentazione anatomica del canale anale con ultrasonografia (US) endoanale 3D

  • Abdominal Radiology / Radiologia Addominale
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

This report describes the advantages of 3D anal endosonography in depicting the normal anatomy of the anal canal in relation to sex and age.

Materials and methods

A retrospective study was performed of 85 patients, 33 men and 52 women, previously examined with 3D anal ultrasound (US) for clinically suspected anorectal disease but found to be negative. The examinations were performed with a Bruel and Kjaer US system with a 2050 transducer, scanning from the anorectal junction to the subcutaneous portion of the external anal sphincter (EAS). The 3D reconstructions provided an estimation of sphincter length in the anterior and posterior planes, and axial 2D images enabled calculation of the thickness of the internal anal sphincter (IAS) and EAS in the anterior, posterior and lateral transverse planes.

Results

Distribution of the sphincter complex is asymmetric in both sexes: the EAS and IAS are significantly shorter in females, especially in the anterior longitudinal plane (p=0.005 and p<0.001, respectively). EAS and IAS thickness increases with age, especially the lateral IAS (R2=0.37, p<0.001) and the posterior EAS (R2=0.29, p=0.01).

Conclusions

A good knowledge of anal-canal anatomy is essential to detect sphincter abnormalities when assessing pelvic floor dysfunction.

Riassunto

Obiettivo

Scopo del presente lavoro è stato documentare la rappresentazione anatomica normale del canale anale attraverso l’ultrasonografia (US) endoanale 3D, in relazione al sesso e all’età.

Materiali e metodi

In uno studio retrospettivo sono stati selezionati 85 soggetti, di cui 33 maschi e 52 femmine, sottoposti precedentemente ad US endoanale 3D per sospetto clinico di patologia dell’ano-retto distale ma risultati essere tutti negativi all’esame ultrasonografico. Gli esami sono stati eseguiti con apparecchio dedicato Bruel e Kjaer, con trasduttore tipo 2050 e scansioni dalla giunzione ano-rettale alla porzione più superficiale dello sfintere anale esterno (SAE). Nell’immediato postprocessing sono stati stimati la lunghezza degli sfinteri nei piani anteriore e posteriore e lo spessore anteriore, laterale e posteriore dello sfintere anale interno (SAI) e del SAE.

Risultati

La distribuzione della muscolatura del canale anale risulta asimmetrica in entrambi i sessi: la lunghezza di SAI e SAE è significativamente più breve nelle donne, specie lungo il piano longitudinale mediano anteriore (p=0,005 e p<0,001, rispettivamente). Inoltre, lo spessore di entrambi gli sfinteri presenta una tendenza all’accrescimento proporzionale all’età del paziente, soprattutto nella porzione laterale per il SAI (R2=0,37, p<0,001) e posteriore per il SAE (R2=0,29, p=0,01).

Conclusioni

La conoscenza precisa delle componenti anatomiche muscolo-legamentose del canale anale è alla base della identificazione delle alterazioni sfinteriali utili alla comprensione dei disturbi del pavimento pelvico.

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Authors and Affiliations

  1. Dipartimento di Internistica Clinica e Sperimentale “F. Magrassi e A. Lanzara”, Sezione di Radiodiagnostica, Seconda Università degli Studi di Napoli, P.zza Miraglia 2, 80138, Napoli, Italy

    A. Reginelli, Y. Mandato, C. Cavaliere, N. L. Pizza, A. Russo, S. Cappabianca, A. Rotondo & R. Grassi

  2. Dipartimento di Scienze della Salute, Università degli Studi del Molise, Campobasso, Italy

    L. Brunese

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  1. A. Reginelli
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  2. Y. Mandato
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  3. C. Cavaliere
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  4. N. L. Pizza
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  5. A. Russo
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  6. S. Cappabianca
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  7. L. Brunese
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Correspondence to Y. Mandato.

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Reginelli, A., Mandato, Y., Cavaliere, C. et al. Three-dimensional anal endosonography in depicting anal-canal anatomy. Radiol med 117, 759–771 (2012). https://doi.org/10.1007/s11547-011-0768-4

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  • DOI: https://doi.org/10.1007/s11547-011-0768-4

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