Comparative effectiveness of imaging modalities for preoperative assessment of anorectal malformation in the pediatric population.

OBJECTIVE: The aim of this study was to compare the accuracy of MRI, colostography/fistulography, and X-ray imaging modalities for preoperative diagnosis of anorectal malformations (ARMs) in pediatric patients. METHODS: This retrospective analysis included a total of 84 pediatric patients with ARMs. Preoperative imaging findings were assessed by 2 radiologists and compared to surgical findings. RESULTS: MRI identified anomalies of the spine in 25 of 84 patients (29.8%), anomalies of the genital system in 7 of 84 patients (8.3%), anomalies of the urinary system in 22 of 84 patients (26.2%), and underdeveloped sphincter muscle complex in 34 of 84 patients (40.5%). In the 44 subjects receiving both MRI and X-ray, MRI was more sensitive in detecting anomalies of spine (18/44 vs. 8/44; P = 0.002), and both correctly identified the distal end of the rectum in 77.3% (34/44) of the cases. In the 24 subjects receiving both MRI and colostography/fistulography, MRI was more accurate in identifying Pena's classification (22/24 vs. 15/24; P = 0.039). Distal end of the rectum was correctly identified in 75.0% (18/24) and 58.3% (14/24) of the cases (P = 0.125). CONCLUSIONS: MRI could clearly reveal fistula anatomy and associated anomalies of ARMs and should be routinely used for preoperative evaluation of ARMs. TYPE OF STUDY: Study of diagnostic test. LEVEL OF EVIDENCE: Level II.

Nonfluoroscopic pressure colostography in the evaluation of genitourinary fistula of anorectal malformations: experience in a resource-poor environment.

BACKGROUND: Radiological imaging is paramount for defining the genitourinary fistulae commonly associated with anorectal malformations prior to definitive surgery. The imaging options are resource-limited in many parts of the world. Nonfluoroscopic pressure colostography after colostomy is a cheap method for the evaluation of anorectal malformations. OBJECTIVE: To describe our experience with nonfluoroscopic pressure colostography in the evaluation of anorectal malformations in boys. MATERIALS AND METHODS: The study included 12 boys with anorectal malformation who had colostomy and nonfluoroscopic pressure-augmented colostography with water-soluble contrast medium between January 2006 and December 2007. RESULTS: Patient ages ranged from 2 days to 1 year. The types of genitourinary fistula were rectovesical (7.7%) and rectourethral (92.3%). Oblique radiographs were of diagnostic value in all patients. The types of anorectal malformations were high, intermediate and low in 75%, 8.3% and 16.7%, respectively. Short-segment urethral constriction was a common feature of rectourethral fistula (75%, n=9). CONCLUSION: Our experience has shown that genitourinary fistulae associated with anorectal malformations can be demonstrated reliably by nonfluoroscopic pressure colostography with two oblique radiographs, providing an option in resource-poor settings where fluoroscopic equipment is scarce.

Ultrasonographic assessment of fetal gender.

The purpose of this study is to evaluate the value and accuracy of ultrasonography in the detection and determination of the gender of the fetus. This prospective study involves the Ultrasound examination of a total of 415 fetuses including 216 (52%) females and 199 (48%) males. The mean gestational age at which the fetuses were scanned was 32 weeks 1 day, with a range of 15 to 40 weeks. Fetal sex identification was only possible in 363 (87.5%) cases. Of these, the fetal sex corroborated birth sex in 314 (75.7%) and disagrees in 49(11.8%) cases. The overall estimated sensitivity of the scan in fetal sex determination is 86.5%, while the estimated specificity for identification of the female sex (90.6%) was higher than that of the male (83.2%). Despite the high efficacy of ultrasound in sex determination obtained in our study, the errors and failure rates should be made known to mothers who are willing to know the gender of their fetuses.

Ancillary tests for assessment of the reproductive system.

Ancillary tests applied to the male reproductive system include semen evaluation, ultrasonography, and testicular biopsy. Venereal disease testing and karyotyping are conducted on both male and female animals. The ancillary tests conducted on the female ruminant include culture, biopsy, cytology, and lavage; oviduct patency; and progesterone analysis. The application and interpretation of these tests as adjuncts to the physical examination of the reproductive system are discussed.