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Transperineal Three-Dimensional Ultrasound Imaging for Detection of Anatomic Defects in the Anal Sphincter Complex Muscles  Milena M. Weinstein, Dolores.

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Presentation on theme: "Transperineal Three-Dimensional Ultrasound Imaging for Detection of Anatomic Defects in the Anal Sphincter Complex Muscles  Milena M. Weinstein, Dolores."— Presentation transcript:

1 Transperineal Three-Dimensional Ultrasound Imaging for Detection of Anatomic Defects in the Anal Sphincter Complex Muscles  Milena M. Weinstein, Dolores H. Pretorius, Sung–Ai Jung, Charles W. Nager, Ravinder K. Mittal  Clinical Gastroenterology and Hepatology  Volume 7, Issue 2, Pages (February 2009) DOI: /j.cgh Copyright © 2009 AGA Institute Terms and Conditions

2 Figure 1 Cross-sectional (axial) 1-mm multislice imaging of the normal anal canal in a nulliparous subject. In this example the anal sphincter complex is shown at every 1-mm distance using the I-Slice function of HD-11 (Philips). Marked in the figure are the IAS (black circle) and the EAS (white outer ring), which are uniform and symmetrical. Clinical Gastroenterology and Hepatology 2009 7, DOI: ( /j.cgh ) Copyright © 2009 AGA Institute Terms and Conditions

3 Figure 2 Cross-sectional (axial) 1-mm multislice images of the anal sphincter complex with less than 50% damage. Damage in the EAS is marked with white arrows, no IAS damage is seen. Clinical Gastroenterology and Hepatology 2009 7, DOI: ( /j.cgh ) Copyright © 2009 AGA Institute Terms and Conditions

4 Figure 3 Cross-sectional (axial) 1-mm multislice images of the anal sphincter complex with 100% damage. Damage of the EAS is marked with a white arrow. Damage in the IAS is shown with black arrows; the IAS has a horse-shoe instead of a circular shape. The shape of the sphincter complex and the anal mucosa are oblong. Clinical Gastroenterology and Hepatology 2009 7, DOI: ( /j.cgh ) Copyright © 2009 AGA Institute Terms and Conditions

5 Figure 4 Examples of the PRM injury on 10-mm, thick-slice images of the PRM. The numbers on each panel shows how each PRM hemisling is scored separately (see the Methods section for details). Clinical Gastroenterology and Hepatology 2009 7, DOI: ( /j.cgh ) Copyright © 2009 AGA Institute Terms and Conditions

6 Figure 5 Dynamic images of the pelvic floor hiatus at rest and during squeeze in the same parous woman. The injury of the puborectalis muscle is accentuated when during the pelvic floor contraction (squeeze) maneuver the pelvic floor hiatus bulges out towards the side of injury (arrow). Clinical Gastroenterology and Hepatology 2009 7, DOI: ( /j.cgh ) Copyright © 2009 AGA Institute Terms and Conditions

7 Figure 6 AP length (mean ± SEM) of the pelvic floor hiatus in the plane of the PRM in the parous (n = 19) and FI patients (n = 25) with different grades of PRM injury. Clinical Gastroenterology and Hepatology 2009 7, DOI: ( /j.cgh ) Copyright © 2009 AGA Institute Terms and Conditions


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