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Endoanal MR Imaging of the Anal Sphincter in Fecal Incontinence¹

¹ From the Department of Radiology, Erasmus Medical Center, Rotterdam, the Netherlands (E.R., J.S., A.W.Z.); and the Department of Radiology, G 1-211, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands (E.R., J.S., J.S.L.). Presented as a scientific exhibit at the 1998 RSNA scientific assembly. Received January 27, 1999; revision requested March 16 and received April 12; accepted April 12. Address reprint requests to E.R.

Fecal incontinence is a major medical and social problem. The most frequent cause is a pathologic condition of the anal sphincter. Endoanal magnetic resonance (MR) imaging allows detailed visualization of the normal anatomy and pathologic conditions of the anal sphincter. The hyperintense internal sphincter appears as a continuation of the smooth muscle of the rectum; the hypointense external sphincter surrounds the lower part of the internal sphincter. A sphincteric defect is seen as a discontinuity of the muscle ring. Scarring appears as a hypointense deformation of the normal pattern of the muscle layer. Two external sphincteric patterns may be misdiagnosed as defects: a posterior discontinuity (often seen in young male patients) and an anterior discontinuity (often seen in female patients). Atrophy of the external sphincter is easily detected on coronal MR images by comparing the thicknesses of all anal muscles. Endoanal MR imaging is superior to endoanal ultrasonography because of the multiplanar capability and higher inherent contrast resolution of the former. Use of endoanal MR imaging may lead to better selection of candidates for surgery and therefore better surgical results. Endoanal MR imaging is the most accurate technique for detection and characterization of sphincteric lesions and planning of optimal therapy.

Index Terms: Anus, abnormalities, 757.40 • Anus, MR, 757.12141 • Magnetic resonance (MR), intracavitary coils, 757.12141