Abdominal Imaging

, Volume 38, Issue 5, pp 952–973 | Cite as

Comparison between dynamic cystocolpoproctography and dynamic pelvic floor MRI: pros and cons: Which is the “functional” examination for anorectal and pelvic floor dysfunction?

  • Dean D. T. MaglinteEmail author
  • Douglass S. Hale
  • Kumar Sandrasegaran


“Functional” imaging of anorectal and pelvic floor dysfunction has assumed an important role in the diagnosis and management of these disorders. Although defecography has been widely practiced for decades to evaluate the dynamics of rectal emptying, debate concerning its clinical relevance, how it should be done and interpreted continues. Due to the recognition of the association of defecatory disorders with pelvic organ prolapse in women, the need to evaluate the pelvic floor as a unit has arisen. To meet this need, defecography has been extended to include not only evaluation of defecation disorders but also the rest of the pelvic floor by opacifying the small bowel, vagina, and the urinary bladder. The term “dynamic cystocolpoproctography” (DCP) has been appropriately applied to this examination. Rectal emptying performed with DCP provides the maximum stress to the pelvic floor resulting in complete levator ani relaxation. In addition to diagnosing defecatory disorders, this method of examination demonstrates maximum pelvic organ descent and provides organ-specific quantification of organ prolapse, information that is only inferred by means of physical examination. It has been found to be of clinical value in patients with defecation disorders and the diagnosis of associated prolapse in other compartments that are frequently unrecognized by history taking and the limitations of physical examination. Pelvic floor anatomy is complex and DCP does not show the anatomical details pelvic magnetic resonance imaging (MRI) provides. Technical advances allowing acquisition of dynamic rapid MRI sequences has been applied to pelvic floor imaging. Early reports have shown that pelvic MRI may be a useful tool in pre-operative planning of these disorders and may lead to a change in surgical therapy. Predictions of hypothetical increase cancer incidence and deaths in patients exposed to radiation, the emergence of pelvic floor MRI in addition to questions relating to the clinical significance of DCP findings have added to these controversies. This review analyses the pros and cons between DCP and dynamic pelvic floor MRI, addresses imaging and interpretive controversies, and their relevance to clinical management.


Dynamic pelvic floor MRI Defecography Pelvic organ prolapse Anorectal disorders Pelvic organ prolapse staging 

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  1. 1.
    DeLancey JO (2005) The hidden epidemic of pelvic floor dysfunction: achievable goals for improved prevention and treatment. Am J Obstet Gynecol 192(5):1488–1495PubMedCrossRefGoogle Scholar
  2. 2.
    Sung VW, Hampton BS (2009) Epidemiology of pelvic floor dysfunction. Obstet Gynecol Clin North Am 36(3):421–443PubMedCrossRefGoogle Scholar
  3. 3.
    Maglinte DD, Kelvin FM, Hale DS, Benson JT (1997) Dynamic cystoproctography: a unifying diagnostic approach to pelvic floor and anorectal dysfunction. AJR Am J Roentgenol 169(3):759–767PubMedCrossRefGoogle Scholar
  4. 4.
    Stoker J, Halligan S, Bartram CI (2001) Pelvic floor imaging. Radiology 218(3):621–641PubMedGoogle Scholar
  5. 5.
    Burhenne HJ (1964) Intestinal evacuation study: a new roentgenologic technique. Radiol Clin 33:79–84PubMedGoogle Scholar
  6. 6.
    Broden B, Snellman B (1968) Procidentia of the rectum studied with cineradiography. A contribution to the discussion of causative mechanism. Dis Colon Rectum 11(5):330–347PubMedCrossRefGoogle Scholar
  7. 7.
    Brown BS (1965) Defecography or anorectal studies in children including cinefluorographic observations. J Can Assoc Radiol 16:66–76PubMedGoogle Scholar
  8. 8.
    Mahieu P, Pringot J, Bodart P (1984) Defecography: I. Description of a new procedure and results in normal patients. Gastrointest Radiol 9(3):247–251PubMedCrossRefGoogle Scholar
  9. 9.
    Mahieu P, Pringot J, Bodart P (1984) Defecography: II. Contribution to the diagnosis of defecation disorders. Gastrointest Radiol 9(3):253–261PubMedCrossRefGoogle Scholar
  10. 10.
    Ekberg O, Nylander G, Fork FT (1985) Defecography. Radiology 155(1):45–48PubMedGoogle Scholar
  11. 11.
    Hoffman MJ, Kodner IJ, Fry RD (1984) Internal intussusception of the rectum. Diagnosis and surgical management. Dis Colon Rectum 27(7):435–441PubMedCrossRefGoogle Scholar
  12. 12.
    Kuijpers HC, Bleijenberg G (1985) The spastic pelvic floor syndrome. A cause of constipation. Dis Colon Rectum 28(9):669–672PubMedCrossRefGoogle Scholar
  13. 13.
    Bartolo DC, Roe AM, Virjee J, Mortensen NJ (1985) Evacuation proctography in obstructed defaecation and rectal intussusception. Br J Surg 72:S111–S116PubMedCrossRefGoogle Scholar
  14. 14.
    Kelvin FM, Maglinte DD, Benson JT (1994) Evacuation proctography (defecography): an aid to the investigation of pelvic floor disorders. Obstet Gynecol 83(2):307–314PubMedGoogle Scholar
  15. 15.
    Kelvin FM, Maglinte DD, Hornback JA, Benson JT (1992) Pelvic prolapse: assessment with evacuation proctography (defecography). Radiology 184(2):547–551PubMedGoogle Scholar
  16. 16.
    Kelvin FM, Maglinte DD (1997) Dynamic cystoproctography of female pelvic floor defects and their interrelationships. AJR Am J Roentgenol 169(3):769–774PubMedCrossRefGoogle Scholar
  17. 17.
    Maglinte DD, Bartram CI, Hale DA, et al. (2011) Functional imaging of the pelvic floor. Radiology 258(1):23–39PubMedCrossRefGoogle Scholar
  18. 18.
    Law YM, Fielding JR (2008) MRI of pelvic floor dysfunction: review. AJR Am J Roentgenol 191(6 Suppl):S45–S53PubMedCrossRefGoogle Scholar
  19. 19.
    Barleben A, Mills S (2010) Anorectal anatomy and physiology. Surg Clin N Am 90(1):1–15 (table of contents)PubMedCrossRefGoogle Scholar
  20. 20.
    Bertschinger KM, Hetzer FH, Roos JE, et al. (2002) Dynamic MR imaging of the pelvic floor performed with patient sitting in an open-magnet unit versus with patient supine in a closed-magnet unit. Radiology 223(2):501–508PubMedCrossRefGoogle Scholar
  21. 21.
    Bharucha AE (2006) Update of tests of colon and rectal structure and function. J Clin Gastroenterol 40(2):96–103PubMedCrossRefGoogle Scholar
  22. 22.
    Cappabianca S, Reginelli A, Iacobellis F, et al. (2011) Dynamic MRI defecography vs. entero-colpo-cysto-defecography in the evaluation of midline pelvic floor hernias in female pelvic floor disorders. Int J Colorectal Dis 26(9):1191–1196PubMedCrossRefGoogle Scholar
  23. 23.
    Comiter CV, Vasavada SP, Barbaric ZL, Gousse AE, Raz S (1999) Grading pelvic prolapse and pelvic floor relaxation using dynamic magnetic resonance imaging. Urology 54(3):454–457PubMedCrossRefGoogle Scholar
  24. 24.
    Eguare EI, Neary P, Crosbie J, et al. (2004) Dynamic magnetic resonance imaging of the pelvic floor in patients with idiopathic combined fecal and urinary incontinence. J Gastrointest Surg 8(1):73–82 (discussion 82)PubMedCrossRefGoogle Scholar
  25. 25.
    El Sayed RF, El Mashed S, Farag A, Morsy MM, Abdel Azim MS (2008) Pelvic floor dysfunction: assessment with combined analysis of static and dynamic MR imaging findings. Radiology 248(2):518–530PubMedCrossRefGoogle Scholar
  26. 26.
    Elshazly WG, El Nekady Ael A, Hassan H (2010) Role of dynamic magnetic resonance imaging in management of obstructed defecation case series. Int J Surg 8(4):274–282PubMedCrossRefGoogle Scholar
  27. 27.
    Hecht EM, Lee VS, Tanpitukpongse TP, et al. (2008) MRI of pelvic floor dysfunction: dynamic true fast imaging with steady-state precession versus HASTE. AJR Am J Roentgenol 191(2):352–358PubMedCrossRefGoogle Scholar
  28. 28.
    Hetzer FH, Andreisek G, Tsagari C, Sahrbacher U, Weishaupt D (2006) MR defecography in patients with fecal incontinence: imaging findings and their effect on surgical management. Radiology 240(2):449–457PubMedCrossRefGoogle Scholar
  29. 29.
    Hilfiker PR, Debatin JF, Schwizer W, et al. (1998) MR defecography: depiction of anorectal anatomy and pathology. J Comput Assist Tomogr 22(5):749–755PubMedCrossRefGoogle Scholar
  30. 30.
    Lamb GM, de Jode MG, Gould SW, et al. (2000) Upright dynamic MR defaecating proctography in an open configuration MR system. Br J Radiol 73(866):152–155PubMedGoogle Scholar
  31. 31.
    Law PA, Danin JC, Lamb GM, et al. (2001) Dynamic imaging of the pelvic floor using an open-configuration magnetic resonance scanner. J Magn Reson Imaging 13(6):923–929PubMedCrossRefGoogle Scholar
  32. 32.
    Lienemann A, Fischer T (2003) Functional imaging of the pelvic floor. Eur J Radiol 47(2):117–122PubMedCrossRefGoogle Scholar
  33. 33.
    Mortele KJ, Fairhurst J (2007) Dynamic MR defecography of the posterior compartment: indications, techniques and MRI features. Eur J Radiol 61(3):462–472PubMedCrossRefGoogle Scholar
  34. 34.
    Rentsch M, Paetzel C, Lenhart M, et al. (2001) Dynamic magnetic resonance imaging defecography: a diagnostic alternative in the assessment of pelvic floor disorders in proctology. Dis Colon Rectum 44(7):999–1007PubMedCrossRefGoogle Scholar
  35. 35.
    Roos JE, Weishaupt D, Wildermuth S, et al. (2002) Experience of 4 years with open MR defecography: pictorial review of anorectal anatomy and disease. Radiographics 22(4):817–832PubMedGoogle Scholar
  36. 36.
    Gousse AE, Barbaric ZL, Safir MH, et al. (2000) Dynamic half Fourier acquisition, single shot turbo spin-echo magnetic resonance imaging for evaluating the female pelvis. J Urol 164(5):1606–1613PubMedCrossRefGoogle Scholar
  37. 37.
    Healy JC, Halligan S, Reznek RH, et al. (1997) Magnetic resonance imaging of the pelvic floor in patients with obstructed defaecation. Br J Surg 84(11):1555–1558PubMedCrossRefGoogle Scholar
  38. 38.
    Gufler H, Laubenberger J, DeGregorio G, Dohnicht S, Langer M (1999) Pelvic floor descent: dynamic MR imaging using a half-Fourier RARE sequence. J Magn Reson Imaging 9(3):378–383PubMedCrossRefGoogle Scholar
  39. 39.
    Schoenenberger AW, Debatin JF, Guldenschuh I, et al. (1998) Dynamic MR defecography with a superconducting, open-configuration MR system. Radiology 206(3):641–646PubMedGoogle Scholar
  40. 40.
    Yang A, Mostwin JL, Rosenshein NB, Zerhouni EA (1991) Pelvic floor descent in women: dynamic evaluation with fast MR imaging and cinematic display. Radiology 179(1):25–33PubMedGoogle Scholar
  41. 41.
    Brenner D, Elliston C, Hall E, Berdon W (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 176(2):289–296PubMedCrossRefGoogle Scholar
  42. 42.
    Hall EJ, Brenner DJ (2008) Cancer risks from diagnostic radiology. Br J Radiol 81(965):362–378PubMedCrossRefGoogle Scholar
  43. 43.
    Brenner DJ, Hall EJ (2007) Computed tomography—an increasing source of radiation exposure. N Engl J Med 357(22):2277–2284PubMedCrossRefGoogle Scholar
  44. 44.
    Brenner DJ, Hall EJ (2004) Risk of cancer from diagnostic X-rays. Lancet 363(9427):2192 (author reply 2192–2193)PubMedCrossRefGoogle Scholar
  45. 45.
    Brenner DJ, Hricak H (2010) Radiation exposure from medical imaging: time to regulate? JAMA 304(2):208–209PubMedCrossRefGoogle Scholar
  46. 46.
    Maglinte DD, Bartram C (2007) Dynamic imaging of posterior compartment pelvic floor dysfunction by evacuation proctography: techniques, indications, results and limitations. Eur J Radiol 61(3):454–461PubMedCrossRefGoogle Scholar
  47. 47.
    Halligan S (1995) Re: The benefits or otherwise of evacuation proctography (defecography). Abdom Imaging 20(3):280–281PubMedGoogle Scholar
  48. 48.
    Halligan S, Malouf A, Bartram CI, et al. (2001) Predictive value of impaired evacuation at proctography in diagnosing anismus. AJR Am J Roentgenol 177(3):633–636PubMedCrossRefGoogle Scholar
  49. 49.
    Maglinte DD, Kelvin FM, Fitzgerald K, Hale DS, Benson JT (1999) Association of compartment defects in pelvic floor dysfunction. AJR Am J Roentgenol 172(2):439–444PubMedCrossRefGoogle Scholar
  50. 50.
    Flusberg M, Sahni VA, Erturk SM, Mortele KJ (2011) Dynamic MR defecography: assessment of the usefulness of the defecation phase. AJR Am J Roentgenol 196(4):W394–W399PubMedCrossRefGoogle Scholar
  51. 51.
    Solopova AE, Hetzer FH, Marincek B, Weishaupt D (2008) MR defecography: prospective comparison of two rectal enema compositions. AJR Am J Roentgenol 190(2):W118–W124PubMedCrossRefGoogle Scholar
  52. 52.
    Bremmer S (1995) Simultaneous defecography and peritoneography in defecation disorders. Dis Colon Rectum 38:969–973PubMedCrossRefGoogle Scholar
  53. 53.
    Halligan S (1996) Dynamic cystoproctography and physiological testing in women with urinary stress incontinence and urogenital prolapse. Clin Radiol 51:785–790PubMedCrossRefGoogle Scholar
  54. 54.
    Halligan S, Bartram C, Hall C, Wingate J (1996) Enterocele revealed by simultaneous evacuation proctography and peritoneography: does “defecation block” exist? Am J Roentgenol 167(2):461–466CrossRefGoogle Scholar
  55. 55.
    Kelvin FM, Maglinte DD, Hale DS, Benson JT (2000) Female pelvic organ prolapse: a comparison of triphasic dynamic MR imaging and triphasic fluoroscopic cystocolpoproctography. AJR Am J Roentgenol 174(1):81–88PubMedCrossRefGoogle Scholar
  56. 56.
    Altringer WE, Saclarides TJ, Dominguez JM, Brubaker LT, Smith CS (1995) Four-contrast defecography: pelvic “floor-oscopy”. Dis Colon Rectum 38(7):695–699PubMedCrossRefGoogle Scholar
  57. 57.
    Brubaker L, Heit MH (1993) Radiology of the pelvic floor. Clin Obstet Gynecol 36(4):952–959PubMedCrossRefGoogle Scholar
  58. 58.
    Hock D, Lombard R, Jehaes C, et al. (1993) Colpocystodefecography. Dis Colon Rectum 36(11):1015–1021PubMedCrossRefGoogle Scholar
  59. 59.
    Kelvin FM, Hale DS, Maglinte DD, Patten BJ, Benson JT (1999) Female pelvic organ prolapse: diagnostic contribution of dynamic cystoproctography and comparison with physical examination. AJR Am J Roentgenol 173(1):31–37PubMedCrossRefGoogle Scholar
  60. 60.
    Saclarides TJ, Brubaker LT, Altringer WE, Smith CS, Dominguez JM (1996) Clarifying the technique of four-contrast defecography. Dis Colon Rectum 39(7):826PubMedCrossRefGoogle Scholar
  61. 61.
    Vanbeckevoort D, Van Hoe L, Oyen R, et al. (1999) Pelvic floor descent in females: comparative study of colpocystodefecography and dynamic fast MR imaging. J Magn Reson Imaging 9(3):373–377PubMedCrossRefGoogle Scholar
  62. 62.
    Fielding JR, Griffiths DJ, Versi E, et al. (1998) MR imaging of pelvic floor continence mechanisms in the supine and sitting positions. AJR Am J Roentgenol 171(6):1607–1610PubMedCrossRefGoogle Scholar
  63. 63.
    Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89(4):501–506PubMedCrossRefGoogle Scholar
  64. 64.
    Gill EJ, Hurt WG (1998) Pathophysiology of pelvic organ prolapse. Obstet Gynecol Clin North Am 25(4):757–769PubMedCrossRefGoogle Scholar
  65. 65.
    Burnett LS, Buckley SL (1993) Surgical failures in the management of pelvic floor relaxation. Curr Opin Obstet Gynecol 5(4):465–470PubMedCrossRefGoogle Scholar
  66. 66.
    Karasick S, Spettell CM (1997) The role of parity and hysterectomy on the development of pelvic floor abnormalities revealed by defecography. AJR Am J Roentgenol 169(6):1555–1558PubMedCrossRefGoogle Scholar
  67. 67.
    Karasick S, Spettell CM (1999) Defecography: does parity play a role in the development of rectal prolapse? Eur Radiol 9(3):450–453PubMedCrossRefGoogle Scholar
  68. 68.
    Stoker J, Bartram CI, Halligan S (2002) Imaging of the posterior pelvic floor. Eur Radiol 12(4):779–788PubMedCrossRefGoogle Scholar
  69. 69.
    Stoker J, Rociu E (1999) Endoluminal MR imaging of anorectal diseases. J Magn Reson Imaging 9(5):631–634PubMedCrossRefGoogle Scholar
  70. 70.
    Kim JK, Kim YJ, Choo MS, Cho KS (2003) The urethra and its supporting structures in women with stress urinary incontinence: MR imaging using an endovaginal coil. Am J Roentgenol 180:1037–1044CrossRefGoogle Scholar
  71. 71.
    Stoker J, Rociu E, Zwamborn AW, Schouten WR, Lameris JS (1999) Endoluminal MR imaging of the rectum and anus: technique, applications, and pitfalls. Radiographics 19:383–398PubMedGoogle Scholar
  72. 72.
    Shorvon PJ, McHugh S, Diamant NE, Somers S, Stevenson GW (1989) Defecography in normal volunteers: results and implications. Gut 30(12):1737–1749PubMedCrossRefGoogle Scholar
  73. 73.
    Fielding JR (1996) Imaging of the female pelvis in the supine and upright position. J Magn Reson Imaging 88:750–756Google Scholar
  74. 74.
    Gagliardi G, Pescatori M, Altomare DF, et al. (2008) Results, outcome predictors, and complications after stapled transanal rectal resection for obstructed defecation. Dis Colon Rectum 51(2):186–195 (discussion 195)PubMedCrossRefGoogle Scholar
  75. 75.
    Bump RC, Mattiasson A, Bo K, et al. (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175(1):10–17PubMedCrossRefGoogle Scholar
  76. 76.
    Bernier P, Stevenson GW, Shorvon PJ (1988) Defecography commode. Radiology 155:891–892Google Scholar
  77. 77.
    Jorge JM, Yang YK, Wexner SD (1994) Incidence and clinical significance of sigmoidocele as determined by a new classification system. Dis Colon Rectum 37(11):1112–1117PubMedCrossRefGoogle Scholar
  78. 78.
    Morandi C, Martellucci J, Talento P, Carriero A (2010) Role of enterocele in the obstructed defecation syndrome (ODS): a new radiological point of view. Colorectal Dis 12:810–816PubMedCrossRefGoogle Scholar
  79. 79.
    Healy JC, Halligan S, Reznek RH, et al. (1997) Dynamic MR imaging compared with evacuation proctography when evaluating anorectal configuration and pelvic floor movement. AJR Am J Roentgenol 169(3):775–779PubMedCrossRefGoogle Scholar
  80. 80.
    Barber MD, Brubaker L, Nygaard I, et al. (2009) Defining success after surgery for pelvic organ prolapse. Obstet Gynecol 114(3):600–609PubMedCrossRefGoogle Scholar
  81. 81.
    Singh K, Reid WM, Berger LA (2001) Assessment and grading of pelvic organ prolapse by use of dynamic magnetic resonance imaging. Am J Obstet Gynecol 185(1):71–77PubMedCrossRefGoogle Scholar
  82. 82.
    Woodfield CA, Hampton BS, Sung V, Brody JM (2009) Magnetic resonance imaging of pelvic organ prolapse: comparing pubococcygeal and midpubic lines with clinical staging. Int Urogynecol J Pelvic Floor Dysfunct 20(6):695–701PubMedCrossRefGoogle Scholar
  83. 83.
    Lockhart ME, Fielding JR, Richter HE, et al. (2008) Reproducibility of dynamic MR imaging pelvic measurements: a multi-institutional study. Radiology 249(2):534–540PubMedCrossRefGoogle Scholar
  84. 84.
    Brenner DJ (2004) Radiation risks potentially associated with low-dose CT screening of adult smokers for lung cancer. Radiology 231(2):440–445PubMedCrossRefGoogle Scholar
  85. 85.
    Brenner DJ (2006) It is time to retire the computed tomography dose index (CTDI) for CT quality assurance and dose optimization. For the proposition. Med Phys 33(5):1189–1190PubMedCrossRefGoogle Scholar
  86. 86.
    Brenner DJ, Sachs RK (2006) Estimating radiation-induced cancer risks at very low doses: rationale for using a linear no-threshold approach. Radiat Environ Biophys 44(4):253–256PubMedCrossRefGoogle Scholar
  87. 87.
    Pfeifer J, Oliveira L, Park UC, et al. (1997) Are interpretations of video defecographies reliable and reproducible? Int J Colorectal Dis 12:67–72PubMedCrossRefGoogle Scholar
  88. 88.
    Kenton K, Shott S, Brubaker L (1997) Vaginal topography does not correlate well with visceral position in women with pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 8(6):336–339PubMedCrossRefGoogle Scholar
  89. 89.
    Altman D, Mellgren A, Kierkegaard J, et al. (2004) Diagnosis of cystocele—the correlation between clinical and radiological evaluation. Int Urogynecol J Pelvic Floor Dysfunct 15(1):3–9 (discussion 9)PubMedCrossRefGoogle Scholar
  90. 90.
    Hale D (2008) Clinical and surgical pelvic organ prolapse. In: Bartram CI, DeLancey JOL (eds) Medical radiology. Diagnostic and radiation oncology: pelvic floor disorders, 2nd edn. Heidelberg: Springer, pp 165–186Google Scholar
  91. 91.
    Benson T (1992) Female pelvic floor disorders: investigation and management. New York: NortonGoogle Scholar
  92. 92.
    Frudinger A, Bartram CI, Halligan S, Kamm M (1998) Examination techniques for endosonography of the anal canal. Abdom Imaging 23(3):301–303PubMedCrossRefGoogle Scholar
  93. 93.
    da Silva GM, Gurland B, Sleemi A, Levy G (2006) Posterior vaginal wall prolapse does not correlate with fecal symptoms or objective measures of anorectal function. Am J Obstet Gynecol 195(6):1742–1747PubMedCrossRefGoogle Scholar
  94. 94.
    Felt-Bersma RJ, Luth WJ, Janssen JJ, Meuwissen SG (1990) Defecography in patients with anorectal disorders. Which findings are clinically relevant? Dis Colon Rectum 33(4):277–284PubMedCrossRefGoogle Scholar
  95. 95.
    Ferrante SL, Perry RE, Schreiman JS, Cheng SC, Frick MP (1991) The reproducibility of measuring the anorectal angle in defecography. Dis Colon Rectum 34(1):51–55PubMedCrossRefGoogle Scholar
  96. 96.
    Bartram CI, Turnbull G, Lennard-Jones JE (1988) Evacuation proctography: an investigation of rectal expulsion in 20 subjects without defecatory disturbance. Gastrointest Radiol 13(1):72–80PubMedCrossRefGoogle Scholar
  97. 97.
    Ott DJ, Donati DL, Kerr RM, Chen MY (1994) Defecography: results in 55 patients and impact on clinical management. Abdom Imaging 19(4):349–354PubMedCrossRefGoogle Scholar
  98. 98.
    Bharucha AE, Wald A, Enck P, et al. (2006) Functional anorectal disorders. Gastroenterology 130:1510–1518PubMedCrossRefGoogle Scholar
  99. 99.
    Halligan S, Bartram CI, Park HY, Kamm MA (1995) Proctographic features of anismus. Radiology 197(3):679–682PubMedGoogle Scholar
  100. 100.
    Bordeianou L, Savitt L, Dursun A (2011) Measurements of pelvic floor dyssynergia: which test result matters? Dis Colon Rectum 54(1):60–65PubMedCrossRefGoogle Scholar
  101. 101.
    Rao SS (2010) Advances in diagnostic assessment of fecal incontinence and dyssynergic defecation. Clin Gastroenterol Hepatol 8(11):910–919PubMedCrossRefGoogle Scholar
  102. 102.
    Rao SS, Go JT (2009) Treating pelvic floor disorders of defecation: management or cure? Curr Gastroenterol Rep 11(4):278–287PubMedCrossRefGoogle Scholar
  103. 103.
    Halligan S, McGee S, Bartram CI (1994) Quantification of evacuation proctography. Dis Colon Rectum 37:1151–1154PubMedCrossRefGoogle Scholar
  104. 104.
    Hiltunen KM, Kolehmainen H, Matikainen M (1994) Does defecography help in diagnosis and clinical decision-making in defecation disorders? Abdom Imaging 19(4):355–358PubMedCrossRefGoogle Scholar
  105. 105.
    Kenton K, Shott S, Brubaker L (1999) The anatomic and functional variability of rectoceles in women. Int Urogynecol J Pelvic Floor Dysfunct 10(2):96–99PubMedCrossRefGoogle Scholar
  106. 106.
    Mellgren A, López A, Schultz I, Anzen B (1998) Rectocele is associated with paradoxical anal sphincter reaction. Int J Colorectal Dis 13(1):13–16PubMedCrossRefGoogle Scholar
  107. 107.
    Siproudhis L, Ropert A, Lucas J, et al. (1992) Defecatory disorders, anorectal and pelvic floor dysfunction: a polygamy? Radiologic and manometric studies in 41 patients. Int J Colorectal Dis 7(2):102–107PubMedCrossRefGoogle Scholar
  108. 108.
    Halligan S, Bartram CI (1995) Is barium trapping in rectoceles significant? Dis Colon Rectum 38(7):764–768PubMedCrossRefGoogle Scholar
  109. 109.
    Greenberg T, Kelvin FM, Maglinte DD (2001) Barium trapping in rectoceles: are we trapped by the wrong definition? Abdom Imaging 26(6):587–590PubMedCrossRefGoogle Scholar
  110. 110.
    Pucciani F, Rottoli ML, Bologna A, et al. (1996) Anterior rectocele and anorectal dysfunction. Int J Colorectal Dis 11(1):1–9PubMedCrossRefGoogle Scholar
  111. 111.
    Grassi R, Pomerri F, Habib F, et al. (1995) Defecography study of outpouchings of the external wall of the rectum: posterior rectocele and ischio-rectal hernia. Radiol Med 90(1/2):44–48PubMedGoogle Scholar
  112. 112.
    Chen HH, Iroatulam A, Alabaz O, et al. (2001) Associations of defecography and physiologic findings in male patients with rectocele. Tech Coloproctol 5(3):157–161PubMedCrossRefGoogle Scholar
  113. 113.
    Bremmer S, Udén R, Mellgren A (1997) Defaeco-peritoneography in the diagnosis of rectal intussusception: a contribution for the discussion of causative mechanism. Acta Radiol 38(4):578–583PubMedGoogle Scholar
  114. 114.
    Pomerri F, Zuliani M, Mazza C, Villarejo F, Scopece A (2001) Defecographic measurements of rectal intussusception and prolapse in patients and in asymptomatic subjects. AJR Am J Roentgenol 176(3):641–645PubMedCrossRefGoogle Scholar
  115. 115.
    Felt-Bersma R, Tiersma ES, Cuesta M (2008) Rectal prolapse, rectal intussusception, rectocele, solitary rectal ulcer syndrome, and enterocele. Gastroenterol Clin North Am 37:647–648CrossRefGoogle Scholar
  116. 116.
    Rutter KR, Riddell RH (1975) The solitary ulcer syndrome of the rectum. Clin Gastroenterol 4(3):505–530PubMedGoogle Scholar
  117. 117.
    Goei R (1990) Anorectal function in patients with defecation disorders and asymptomatic subjects: evaluation with defecography. Radiology 174(1):121–123PubMedGoogle Scholar
  118. 118.
    Halligan S, Nicholls RJ, Bartram CI (1995) Evacuation proctography in patients with solitary rectal ulcer syndrome: anatomic abnormalities and frequency of impaired emptying and prolapse. Am J Roentgenol 164:91–95CrossRefGoogle Scholar
  119. 119.
    Parks AG, Porter NH, Hardcastle J (1966) The syndrome of the descending perineum. Proc R Soc Med 59(6):477–482PubMedGoogle Scholar
  120. 120.
    Pinho M, Yoshioka K, Ortiz J, Oya M, Keighley MR (1990) The effect of age on pelvic floor dynamics. Int J Colorectal Dis 5(4):207–208PubMedCrossRefGoogle Scholar
  121. 121.
    Bremmer S, Mellgren A, Holmstrom B, Lopez A, Uden R (1997) Peritoneocele: visualization with defecography and peritoneography performed simultaneously. Radiology 202(2):373–377PubMedGoogle Scholar
  122. 122.
    Jorge JM, Ger GC, Gonzalez L, Wexner SD (1994) Patient position during einedefecography: influence on perineal descent and other measurements. Dis Colon Rectum 37(9):927–931PubMedCrossRefGoogle Scholar
  123. 123.
    Berkelmans I, Heresbach D, Leroi AM, et al. (1995) Perineal descent at defecography in women with straining at stool: a lack of specificity or predictive value for future anal incontinence? Eur J Gastroenterol Hepatol 7(1):75–79PubMedGoogle Scholar
  124. 124.
    Tsiaoussis J, Chrysos E, Glynos M, Vassilakis JS, Xynos E (1998) Pathophysiology and treatment of the anterior rectal mucosal prolapse syndrome. Br J Surg 85(12):1699–1702PubMedCrossRefGoogle Scholar
  125. 125.
    Wallden L (1952) Defecation block in cases of deep rectogenital pouch. Acta Chir Scand 103(3):236–238PubMedGoogle Scholar
  126. 126.
    Fenner DE (1996) Diagnosis and assessment of sigmoidoceles. Am J Obstet Gynecol 175(6):1438–1441 (discussion 1441–1432)PubMedCrossRefGoogle Scholar
  127. 127.
    Pannu HK, Kaufman HS, Cundiff GW, et al. (2000) Dynamic MR imaging of pelvic organ prolapse: spectrum of abnormalities. Radiographics 20(6):1567–1582PubMedGoogle Scholar
  128. 128.
    Rooney K, Kenton K, Mueller ER, FitzGerald MP, Brubaker L (2006) Advanced anterior vaginal wall prolapse is highly correlated with apical prolapse. Am J Obstet Gynecol 195(6):1837–1840PubMedCrossRefGoogle Scholar
  129. 129.
    Halligan S, Spence-Jones C, Kamm MA, Bartram CI (1996) Dynamic cystoproctography and physiological testing in women with urinary stress incontinence and urogenital prolapse. Clin Radiol 51(11):785–790PubMedCrossRefGoogle Scholar
  130. 130.
    Dixon A (1997) Evidence based diagnostic radiology. Lancet 350:509–512PubMedCrossRefGoogle Scholar
  131. 131.
    Harvey CJ, Harvey CJ, Halligan S, et al. (1999) Evacuation proctography: a prospective study of diagnostic and therapeutic impact. Radiology 211:223–227PubMedGoogle Scholar
  132. 132.
    Brenner DJ (2002) Estimating cancer risks from pediatric CT: going from the qualitative to the quantitative. Pediatr Radiol 32(4):228–233 (discussion 242–224)PubMedCrossRefGoogle Scholar
  133. 133.
    Brenner DJ (2010) Should we be concerned about the rapid increase in CT usage? Rev Environ Health 25(1):63–68PubMedCrossRefGoogle Scholar
  134. 134.
    Brenner DJ (2010) Slowing the increase in the population dose resulting from CT scans. Radiat Res 174(6):809–815PubMedCrossRefGoogle Scholar
  135. 135.
    Brenner DJ, Elliston CD (2004) Estimated radiation risks potentially associated with full-body CT screening. Radiology 232(3):735–738PubMedCrossRefGoogle Scholar
  136. 136.
    Mahesh M, Hevezi JM (2009) Multislice scanners and radiation dose. J Am Coll Radiol 6(2):127–128PubMedCrossRefGoogle Scholar
  137. 137.
    Brenner DJ, Shuryak I, Einstein AJ (2011) Impact of reduced patient life expectancy on potential cancer risks from radiologic imaging. Radiology 261(1):193–198PubMedCrossRefGoogle Scholar
  138. 138.
    Cohen MD (2009) More on the risks associated with radiation. J Am Coll Radiol 6(6):463PubMedCrossRefGoogle Scholar
  139. 139.
    Thrall JH (2009) Radiation exposure: politics and opinion vs science and pragmatism. J Am Coll Radiol 6(3):133–134PubMedCrossRefGoogle Scholar
  140. 140.
    Mahesh M, Hevezi JM (2009) Slice wars vs dose wars in multiple-row detector CT. J Am Coll Radiol 6(3):201–202PubMedCrossRefGoogle Scholar
  141. 141.
    Pierce DA, Preston DL (2000) Radiation-related cancer risks at low doses among atomic bomb survivors. Radiat Res 154(2):178–186PubMedCrossRefGoogle Scholar
  142. 142.
    Cohen BL (2002) Cancer risk from low-level radiation. AJR Am J Roentgenol 179(5):1137–1143PubMedCrossRefGoogle Scholar
  143. 143.
    Pukkala E, Aspholm R, Auvinen A, et al. (2002) Incidence of cancer among Nordic airline pilots over five decades: occupational cohort study. BMJ 325(7364):567PubMedCrossRefGoogle Scholar
  144. 144.
    Hammer GP, Seidenbusch MC, Regulla DF, et al. (2011) Childhood cancer risk from conventional radiographic examinations for selected referral criteria: results from a large cohort study. AJR Am J Roentgenol 197(1):217–223PubMedCrossRefGoogle Scholar
  145. 145.
    Amis ES Jr (2011) CT radiation dose: trending in the right direction. Radiology 261(1):5–8PubMedCrossRefGoogle Scholar
  146. 146.
    Goei R, Kemmerink G (1990) Radiation dose in defecography. Radiology 176(1):137–139PubMedGoogle Scholar
  147. 147.
    Health Physics Society. McLean V. Radiation risk in perspective. Accessed July 18, 2011.

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Dean D. T. Maglinte
    • 1
    Email author
  • Douglass S. Hale
    • 2
  • Kumar Sandrasegaran
    • 1
  1. 1.Department of Radiology and Imaging SciencesIndiana University School of Medicine, Indiana University HospitalIndianapolisUSA
  2. 2.Section of UrogynecologyIndiana University Health/Methodist Hospital of Indiana, Indiana University School of MedicineIndianapolisUSA

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