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MR Defecography: Prospective Comparison of Two Rectal Enema Compositions

¹ Institute of Diagnostic Radiology, University Hospital Zürich, Rämistrasse 100, CH-8091 Zürich, Switzerland.
² Visceral Surgery, Kantonspital St. Gallen, St. Gallen, Switzerland.

View larger version (13K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Viscosity characteristics of different contrast enema compositions. All measurements were performed at 37°C.

View larger version (129K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Midsagittal contrast-enhanced T1-weighted spoiled gradient-recalled echo MR images (TR/TE, 22.4/10.7) obtained in 64-year-old woman with fecal incontinence and history of hysterectomy in sitting position. With potato starch as rectal enema, large anterior rectocele (sagittal diameter, 63 mm, black arrow) is visible with incomplete evacuation. In addition, enterocele and severe rectal descent are noted. White arrows = anterior rectocele.

View larger version (144K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Midsagittal contrast-enhanced T1-weighted spoiled gradient-recalled echo MR images (TR/TE, 22.4/10.7) obtained in 64-year-old woman with fecal incontinence and history of hysterectomy in sitting position. When ultrasound gel is used as rectal enema, diameter of anterior rectocele is smaller (40 mm, black arrow) and there is nearly complete evacuation of contrast agent. Other findings are similar. White arrows = anterior rectocele.

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Midsagittal contrast-enhanced T1-weighted spoiled gradient-recalled echo MR images (TR/TE, 22.4/10.7) obtained in 47-year-old woman in sitting position at end of defecation. When potato starch is used, anterior rectocele (arrow) measuring 33 mm in diameter and circumferential mural intussusception (arrowheads) extending into rectal ampulla are clearly visualized.

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Midsagittal contrast-enhanced T1-weighted spoiled gradient-recalled echo MR images (TR/TE, 22.4/10.7) obtained in 47-year-old woman in sitting position at end of defecation. When ultrasound gel is used, rectocele (arrow) is smaller (20 mm) when potato starch is used (A). Visibility of intrarectal intussusception (arrowheads) is similar using both rectal compositions, but thickness is measured greater when using potato starch than when using ultrasound gel as rectal enema (anterior thickness, 12 vs 10 mm, respectively; posterior thickness, 22 vs 17 mm). In addition, severe rectal descents are clearly seen using both rectal enema compositions.

View larger version (103K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —Midsagittal contrast-enhanced T1-weighted spoiled gradient-recalled echo MR images (TR/TE, 22.4/10.7) obtained in 47-year-old woman in sitting position at end of defecation. Image shows how length (white arrows) and thickness (black arrows) of anterior and posterior compartments of intussusception were measured.

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Midsagittal contrast agent-enhanced T1-weighted spoiled gradient-recalled echo MR images (TR/TE, 22.4/10.7) obtained in 61-year-old woman after hysterectomy in sitting position at end of defecation. Small bladder descent (1), which measured 17 mm on A and 14 mm on B, and moderate enterocele (2), which measured 51 mm on A and 54 mm on B, could be clearly identified and measured with regard to pubococcygeal line (PCL) on both images. B = bladder, E = enterocele. With potato starch as rectal enema, circumferential mural intussusception extending into rectal ampulla (white arrows) is clearly visible. In addition, large (55 mm) anterior rectocele with incomplete evacuation (black arrow) can be identified.

View larger version (102K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Midsagittal contrast agent-enhanced T1-weighted spoiled gradient-recalled echo MR images (TR/TE, 22.4/10.7) obtained in 61-year-old woman after hysterectomy in sitting position at end of defecation. Small bladder descent (1), which measured 17 mm on A and 14 mm on B, and moderate enterocele (2), which measured 51 mm on A and 54 mm on B, could be clearly identified and measured with regard to pubococcygeal line (PCL) on both images. B = bladder, E = enterocele. When ultrasound gel is used, intussusception contours (white arrows) are less clearly delineated and anterior rectocele (black arrow) is smaller (40 mm) than when potato starch is used (A).

View larger version (108K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —Midsagittal contrast-enhanced T1-weighted spoiled gradient-recalled echo MR images (TR/TE, 22.4/10.7) obtained in 57-year-old man with chronic constipation in sitting position during straining. When potato starch is used as enema, moderate anterior rectocele (arrows) is visible (sagittal diameter, 29 mm).

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —Midsagittal contrast-enhanced T1-weighted spoiled gradient-recalled echo MR images (TR/TE, 22.4/10.7) obtained in 57-year-old man with chronic constipation in sitting position during straining. Anterior rectocele (arrows) is smaller (18 mm) when measured with ultrasound gel enema than with potato starch enema (A). Visibility of severe rectal decent does not change with enema composition.

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