The diagnostic accuracy of endovaginal and transperineal ultrasound for detecting anal sphincter defects : the PREDICT study
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Date
Authors
Roos, A-M.
Abdool, Zeelha
Sultan, Abdul H.
Thakar, Ranee
Journal Title
Journal ISSN
Volume Title
Publisher
Elsevier
Abstract
AIM: To determine the accuracy and predictive value of transperineal (TPU) and endovaginal
ultrasound (EVU) in the detection of anal sphincter defects in women with obstetric anal
sphincter injuries and/or postpartum symptoms of faecal incontinence.
MATERIALS AND METHODS: One hundred and sixty-five women were recruited, four
women were excluded as they were seen years after their last delivery. TPU and EVU, followed
by endonanal ultrasound (EAU), were performed using the B&K Viking 2400 scanner. Sensitivity
and specificity, as well as predictive values with 95% confidence intervals, for detecting
anal sphincter defects were calculated for EVU and TPU, using EAU as the reference standard.
RESULTS: On EAU a defect was found in 42 (26%) women: 39 (93%) had an external (EAS) and
23 (55%) an internal anal sphincter (IAS) defect. Analysable images of one level of the EAS
combined with an analysable IAS were available in 140 (87%) women for EVU and in 131 (81%)
for TPU. The sensitivity and specificity for the detection of any defect was 48% (30e67%) and
85% (77e91%) for EVU and 64% (44e81%) and 85% (77e91%) for TPU, respectively.
CONCLUSION: Although EAU using a rotating endoprobe is the validated reference standard
in the identification of anal sphincter defects, it is not universally available. However while TPU
and/or EVU with conventional ultrasound probes can be useful in identifying normality, for
clinical purposes they are not sensitive enough to identify an underlying sphincter defect.
Description
Keywords
Endovaginal, Transperineal ultrasound, Anal sphincter
Sustainable Development Goals
Citation
Roos A-M, et al., The diagnostic accuracy of endovaginal and transperineal ultrasound for detecting anal sphincter defects : the PREDICT study, Clinical Radiology (2011), doi:10.1016/j.crad.2010.11.017