BACKGROUND: In recent decades, magnetic resonance imaging (MRI) has gained prominence as a standard diagnostic method for preoperative assessment in patients with anorectal malformations and a colostomy, with the potential to replace the classic fluoroscopic distal pressure colostogram (FDPC). Three MRI techniques are available: MRI-distal pressure colostogram with gadolinium (MRI-DPCG) or saline (MRI-DPCS) instillation into the colostomy and native MRI without colostomy instillation. OBJECTIVE: To evaluate and compare the diagnostic accuracy of MRI (native MRI, MRI-DPCG and MRI-DPCS) in the preoperative workup of boys with an anorectal malformation and a colostomy and to compare it to FDPC. MATERIALS AND METHODS: Sixty-two boys with preoperative MRI using one of the three approaches and 43 with FDPC met the inclusion criteria for this retrospective study. The presence and localization of rectal fistulas according to the Krickenbeck classification were evaluated and compared with intraoperative findings. RESULTS: The accuracy of fistula detection for MRI in general (regardless of the technique), MRI-DPCS, MRI-DPCG, native MRI and FDPC was 95% (59/62, P<0.001), 100% (12/12, P=0.03), 100% (30/30, P<0.001), 85% (17/20, P=0.41) and 72% (31/43, P=0.82), respectively. The accuracy of describing fistula type in patients with a correctly detected fistula using these methods was 96% (45/47, P<0.001), 100% (9/9, P<0.001), 100% (23/23, P<0.001), 87% (13/15, P<0.001) and 67% (13/21, P=0.002), respectively. CONCLUSION: MRI is a reliable method for detecting and classifying fistulas in boys with an anorectal malformation and a colostomy and can be considered the modality of first choice for preoperative workup.

• MeSH
• Anorectal Malformations * diagnostic imaging   surgery   MeSH
• Colostomy MeSH
• Humans MeSH
• Magnetic Resonance Spectroscopy MeSH
• Magnetic Resonance Imaging methods   MeSH
• Rectal Fistula * surgery   MeSH
• Rectum diagnostic imaging   surgery   abnormalities   MeSH
• Retrospective Studies MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

Contrast fistulogram (FG) and distal pressure colostogram (DPCG) are standard diagnostic methods for the assessment of anorectal malformations. Pelvic magnetic resonance imaging (MRI) earned a place among essential diagnostic methods in preoperative investigations after the Currarino syndrome and a high incidence of associated spinal dysraphism were described. The aim of our study was to evaluate the possibility of substituting FG and DPCG by a modified pelvic MRI, e.g. MRI fistulogram (MRI-FG) and MRI colostogram (MRI-DPCG). The prospective study involved 29 patients with anorectal malformations who underwent a modified pelvic MRI. The length and course of fistulas and rectum, and the presence of sacral anomalies were studied on MRI images and compared with images obtained by radiologic examinations. Modified MRI brought identical results as contrast studies in 25 patients when related to the fistula and rectum length and course. MRI was more accurate for the detection of sacral anomalies. MRI-FG was the only imaging method used in the four most recent patients. The results support the assumption that conventional contrast examinations for the assessment of anorectal malformations can be replaced by MRI, thus reducing the radiation dose.

• MeSH
• Anal Canal abnormalities   pathology   MeSH
• Anesthesia, General MeSH
• Infant MeSH
• Colostomy MeSH
• Contrast Media administration & dosage   MeSH
• Sacrum abnormalities   MeSH
• Humans MeSH
• Magnetic Resonance Imaging methods   MeSH
• Abnormalities, Multiple MeSH
• Urinary Fistula congenital   diagnosis   surgery   MeSH
• Anus Diseases congenital   diagnosis   surgery   MeSH
• Urethral Diseases congenital   diagnosis   surgery   MeSH
• Urinary Bladder Diseases congenital   diagnosis   surgery   MeSH
• Infant, Premature, Diseases diagnosis   surgery   MeSH
• Infant, Premature MeSH
• Infant, Low Birth Weight MeSH
• Infant, Newborn MeSH
• Perineum pathology   MeSH
• Preoperative Care methods   MeSH
• Prospective Studies MeSH
• Rectal Fistula congenital   diagnosis   surgery   MeSH
• Rectovaginal Fistula congenital   diagnosis   surgery   MeSH
• Rectum abnormalities   pathology   MeSH
• Spinal Dysraphism diagnosis   pathology   MeSH
• Intestinal Fistula congenital   diagnosis   surgery   MeSH
• Check Tag
• Infant MeSH
• Humans MeSH
• Male MeSH
• Infant, Newborn MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Clinical Trial MeSH
• Research Support, Non-U.S. Gov't MeSH