Malakeh Malekzadeh, Shahrokh Abbasi-Rad, Joyce H Keyak, Mahnaz Nabil, Mojgan Asadi, Nazanin Mobini, Parisa Naghdi, Hamid Emadi, Hamidreza Saligheh Rad and Mohammad Bagher Shiran
Objective: We aimed to study the kinematic indices of the pelvic ﬂoor, anorectal angle and the descent of perinea, and the differing movement, in dyssynergic defecation patients in comparison with healthy controls, based on MR defecography.
Methods: Twenty-two individuals involved with dyssynergic defecation constipation and fourteen healthy asymptomatic subjects fell into this study. In four dynamic pelvic ﬂoor MRI indices, namely paradox (unusual change of anorectal angle), perineal descent during straining, perineal ascent, and narrowing of anorectal angle at squeeze, were measured in patients and healthy subjects.
Results: Paradox Index had the highest sensitivity (95.45%) and specifcity (92.86%) for detection of dyssynergic defecation, with an R2 value of near 1 (0.902). The sensitivity and specifcity of other indices were not high; therefore, no signifcant improvement could be achieved using other indices along with Paradox Index. Negative Predictive Value (92.85%) and Positive Predictive Value (95.45%) were only high in Paradox Index.
Conclusion: Paradox Index was indicated to be the best fnding of MR defecography for identifying dyssynergic defecation patients from healthy controls. Hence, MR defecography could be exploited as an authentic tool to manifest the patients the paradoxical function and the relevant muscles of pelvic ﬂoor, which could enhance their imagination of the correct defecation pattern during their treatment