EFSUMB Recommendations for Gastrointestinal Ultrasound Part 3: Endorectal, Endoanal and Perineal Ultrasound

Dieter Nuernberg, Adrian Saftoiu, Ana Paula Barreiros, Eike Burmester, Elena Tatiana Ivan, Dirk-André Clevert, Christoph F Dietrich, Odd Helge Gilja, Torben Lorentzen, Giovanni Maconi, Ismail Mihmanli, Christian Pallson Nolsoe, Frank Pfeffer, Søren Rafael Rafaelsen, Zeno Sparchez, Peter Vilmann, Jo Erling Riise Waage, Dieter Nuernberg, Adrian Saftoiu, Ana Paula Barreiros, Eike Burmester, Elena Tatiana Ivan, Dirk-André Clevert, Christoph F Dietrich, Odd Helge Gilja, Torben Lorentzen, Giovanni Maconi, Ismail Mihmanli, Christian Pallson Nolsoe, Frank Pfeffer, Søren Rafael Rafaelsen, Zeno Sparchez, Peter Vilmann, Jo Erling Riise Waage

Abstract

This article represents part 3 of the EFSUMB Recommendations and Guidelines for Gastrointestinal Ultrasound (GIUS). It provides an overview of the examination techniques recommended by experts in the field of endorectal/endoanal ultrasound (ERUS/EAUS), as well as perineal ultrasound (PNUS). The most important indications are rectal tumors and inflammatory diseases like fistula and abscesses in patients with or without inflammatory bowel disease (IBD). PNUS sometimes is more flexible and convenient compared to ERUS. However, the technique of ERUS is quite well established, especially for the staging of rectal cancer. EAUS also gained ground in the evaluation of perianal diseases like fistulas, abscesses and incontinence. For the staging of perirectal tumors, the use of PNUS in addition to conventional ERUS could be recommended. For the staging of anal carcinomas, PNUS can be a good option because of the higher resolution. Both ERUS and PNUS are considered excellent guidance methods for invasive interventions, such as the drainage of fluids or targeted biopsy of tissue lesions. For abscess detection and evaluation, contrast-enhanced ultrasound (CEUS) also helps in therapy planning.

Keywords: endoanal ultrasound; endorectal ultrasound; perineal ultrasound.

Conflict of interest statement

Conflict of Interest Representative: Conflict of Interest Adrian Saftoiu: Speaker honoraria: Pentax Medical Singapore Ltd+Consulting / Advisory board: Mediglobe Corporation Gmbh; Dirk-André Clevert: Speaker honoraria: Bracco, Siemens, Philips, Samsung, GE, Falk+Board Member: Siemens, Philips, Samsung; Odd Helge Gilja: Speaker honoraria from the following companies: AbbVie, Bracco, Almirall, GE Healthcare, Takeda AS, Meda AS, Ferring AS and Allergan+Consultant fee for: Bracco, GE Healthcare, Takeda and Samsung; Christoph F Dietrich: Speaker honoraria: Bracco, Hitachi, GE, Mindray, Supersonic, Pentax, Olympus, Fuji, Boston Scientific, AbbVie, Falk Foundation, Novartis, Roche Advisory+Board Member: Hitachi, Mindray, Siemens+Research grant, GE, Mindray, SuperSonic; Giovanni Maconi: Speaker honoraria: Abbvie, Alfa Sigma, Janssen-Cilag+Advisory Board/Consultant fee, Allergan, Novartis, Takeda, THD; Dieter Nuernberg: Speaker honoraria: Falk Foundation+Research grant: GE Healthcare; Peter Vilmann: Speaker Honoraria: Pentax Medical Europe, Norgine+Consulting / Advisory board: Mediglobe Corporation Gmbh+ Consulting: Boston Scientific; Eike Burmester: Speaker honoraria Hitachi Medical Systems, Olympus; The following members declared no conflicts of interest: Ana Barreiros, Elena Tatiana Ivan, Ismail Mihmanli, Christian Pallson Nolsoe, Frank Pfeffer, Søren R Rafaelsen, Jo E.R. Waage.

Figures

Fig. 1
Fig. 1
aBiopsy proven circumferential rectal adenocarcinoma visualized endoscopically at 8 cm from the anal verge (red arrows).bRadial endorectal ultrasound (ERUS) showed the hypoechoic mass (red arrows) extending beyond the muscularis propria in the perirectal fat (uT3) (courtesy of Adrian Săftoiu, Elena Tatiana Ivan).
Fig. 2
Fig. 2
Contrast-enhanced radial endorectal ultrasound (ERUS) showing a hyperenhanced (hypervascular) semi-circumferential rectal tumor (red arrows), with an area of un-enhanced central necrosis (courtesy of Adrian Săftoiu, Elena Tatiana Ivan).
Fig. 3
Fig. 3
Radial endorectal ultrasound (ERUS) elastography showing a hard (low strain) perirectal lymph node (red arrows) in a patient with concomitant rectal adenocarcinoma. A balloon surrounding the transducer is inflated with water to improve acoustic coupling with the rectal wall (courtesy of Adrian Săftoiu, Elena Tatiana Ivan).
Fig. 4
Fig. 4
abHypoechoic tumor mass (red arrows) extending beyond the muscularis propria layer (T3), examined with a rigid end-fire probe (courtesy of Søren Rafaelsen).
Fig. 5
Fig. 5
aAdvanced rectal tumor visualized endoscopically as a large vegetating tumor.bRadial endorectal ultrasound (ERUS) delineates the tumor as a hypoechoic mass extending beyond the muscularis propria (red arrows) but with clear delimitation from the prostate (T3) (courtesy of Adrian Săftoiu, Elena Tatiana Ivan).
Fig. 6
Fig. 6
aHistological proven, endoscopically resected T1 rectal adenocarcinoma (red arrows).bEarly rectal adenocarcinoma (uT1) limited to the submucosa, visualized by endorectal strain elastography as a hard (low strain) mass at 12 to 1 o’clock (courtesy of Eike Burmester, Frank Pfeffer).
Fig. 7
Fig. 7
abEarly rectal neuroendocrine tumor visualized endoscopically as a small mass with normal appearing mucosa, completely resected by endoscopic mucosal resection.cdRadial endorectal ultrasound (ERUS) delineates the small tumor (red arrows) as a hypoechoic mass, hard by elastography, limited to the mucosa, with clear demarcation from the submucosa and muscularis propria (T1). Water has been instilled in the balloon covering the ultrasound transducer, as well as in the rectum for better acoustic coupling between the transducer and rectal structures (courtesy of Adrian Săftoiu, Elena Tatiana Ivan).
Fig. 8
Fig. 8
aColor flow imaging showing the Doppler appearance of a hypervascular inflammed anal region.bEndoanal ultrasound (EAUS) with a 360-degree radial transducer showing the muscular layers of the anal canal (red arrows), as well as the soft appearance of an inflammed anal sphincter region (courtesy of Christoph F. Dietrich).
Fig. 9
Fig. 9
The U-shaped puborectalis muscle visualized with 3D radial endoanal ultrasound (red arrows) (courtesy of Eike Burmester).
Fig. 10
Fig. 10
Linear endoanal ultrasound (EAUS) showing the tumor (red arrows) extension from the anodermal junction, as well as thickness, with an oval, hypoechoic, well demarcated lymph node of 15 mm in the perirectal fat shown between markers (uT3N1) (courtesy of Christian Nolsøe, Torben Lorentzen).
Fig. 11
Fig. 11
aRadial endoanal ultrasound (EAUS) of an anal carcinoma (red arrows) extending beyond the anal sphincter shown between markers (uT3).b3D reconstruction of the anal canal, including the tumor (red arrows), which can be precisely measured.cLinear endoanal ultrasound (EAUS) showing the tumor extension (red arrows) from the anodermal junction, as well as thickness.dRound, hypoechoic, well demarcated lymph node (red arrows) in the perirectal fat shown between markers (uN1) (courtesy of Christian Nolsøe, Torben Lorentzen).
Fig. 12
Fig. 12
Endoanal ultrasound (EAUS) with 3D reconstructions, showing a cryptoglandular fistula (blue arrows) with a dorsal abscess in between red arrows (courtesy of Eike Burmester).
Fig. 13
Fig. 13
Recto-vaginal fistula containing fluid and gas (red arrows), visualized through a transrectal approach with a linear endoanal ultrasound (EAUS) probe (courtesy of Christian Nolsøe, Torben Lorentzen).
Fig. 14
Fig. 14
Echorich, air-bubble filled supra-sphincteric Crohnʼs fistula (red arrows) visualized with radial endoanal ultrasound (EAUS) at 2–3 and 6 o´clock position (courtesy of Eike Burmester).
Fig. 15
Fig. 15
aAnterior half of internal sphincter (IS) defect (red arrows) visualized by radial endoanal ultrasound (EAUS).bRadial EAUS of an anteriorly located fistula (between calipers), with an endoanal image (360°) showing 12 o’clock inter-sphincteric portion of the fistula (red arrow).cPerineal ultrasound (PNUS) view with a high frequency linear transducer depicts well the other portion of the fistula in between calipers (arrowhead), which is out of field of view for endoanal image (courtesy of Ismail Mihmanli).
Fig. 16
Fig. 16
Trans-sphincteric fistula (red arrow) visualized with linear EAUS, with the IAS and EAS marked by small and large stars, respectively (courtesy of Christian Nolsøe, Torben Lorentzen).
Fig. 17
Fig. 17
Endoanal two-dimensional axial ultrasound image of the levator hiatus, measured in terms of both area (dash lines) and antero-posterior diameter (red arrow). PRM: puborectal muscle; AC: anal canal; UT: lower level of uterus (courtesy of Ismail Mihmanli).
Fig. 18
Fig. 18
aAnal carcinoma visualized with a linear endoanal ultrasound (EAUS) probe as a hypoechoic tumor mass (red arrows).bTargeted EAUS Trucut biopsy of the anal carcinoma (red arrows) (courtesy of Christian Nolsøe, Torben Lorentzen).
Fig. 19
Fig. 19
aRectovaginal fistula (arrow) in a Crohn’s disease patient visualized by gas in the fistula (PNUS).bPNUS with a higher resolution by using a high frequency probe (courtesy of Dieter Nuernberg).
Fig. 20
Fig. 20
aTrans-sphincteric fistula (red arrows) visualized with perineal ultrasound (PNUS) in the extrasphincteric course.bPNUS elastography showing the soft (compressible) fistula tract (red arrows).cEndoanal ultrasound (EAUS) appearance of the rest of the fistula tract (red arrow) (courtesy of Christoph F. Dietrich).
Fig. 21
Fig. 21
aSuperficial perineal abscess with gas inside (red arrows) and echo-poor inflammatory surrounding (PNUS).bFistula draining the abscess (red arrows) (courtesy of Dieter Nuernberg).
Fig. 22
Fig. 22
Anal abscess (red arrows) drained with a perineal ultrasound (PNUS) guided approach with an end-fire probe (courtesy of Christian Nolsøe, Torben Lorentzen).

References

    1. Kim M J. Transrectal ultrasonography of anorectal diseases: Advantages and disadvantages. Version 2. Ultrasonography. 2015;34:19–31.
    1. Cârţână E T, Pârvu D, Săftoiu A. Endoscopic ultrasound: Current role and future perspectives in managing rectal cancer patients. J Gastrointestin Liver Dis. 2011;20:407–413.
    1. Kav T, Bayraktar Y. How useful is rectal endosonography in the staging of rectal cancer? World J Gastroenterol. 2010;16:691–697.
    1. Steele S R, Martin M J, Place R J. Flexible endorectal ultrasound for predicting pathologic stage of rectal cancers. Am J Surg. 2002;184:126–130.
    1. Colaiácovo R, Assef M S, Ganc R L et al.Rectal cancer staging: Correlation between the evaluation with radial echoendoscope and rigid linear probe. Endosc Ultrasound. 2014;3:161–166.
    1. Fábián A, Bor R, Farkas K, Bálint A et al.Rectal tumor staging with endorectal ultrasound: Is there any difference between western and eastern european countries? Gastroenterol Res Pract. 2016;2016:8.631381E6.
    1. Ustundag Y, Fusaroli P. Are rigid probes sufficient to provide reliable data for rectal cancer staging? Endosc Ultrasound. 2015;4:270.
    1. Cârţână E T, Gheonea D I, Săftoiu A. Advances in endoscopic ultrasound imaging of colorectal diseases. World J Gastroenterol. 2016;22:1756–1766.
    1. Giovannini M, Ardizzone S. Anorectal ultrasound for neoplastic and inflammatory lesions. Best Pract Res Clin Gastroenterol. 2006;20:113–135.
    1. Dietrich C F, Averkiou M A, Correas J M et EFSUMB introduction into dynamic contrast-enhanced ultrasound (DCE-US) for quantification of tumor perfusion. Ultraschall Med. 2012;14:344–351.
    1. Piscaglia F, Nolsøe C, Dietrich C F et al.The EFSUMB guidelines and recommendations on the clinical practice of contrast Enhanced Ultrasound (CEUS): Update 2011 on non-hepatic applications. Ultraschall Med. 2012;33:33–59.
    1. Lu M, Yan B, Song J et al.Double-contrast-enhanced sonography for diagnosis of rectal lesions with pathologic correlation. J Ultrasound Med. 2014;33:575–583.
    1. Wang Y, Li L, Wang Y X, Cui N Y, Zou S M, Zhou C W et al.Time-intensity curve parameters in rectal cancer measured using endorectal ultrasonography with sterile coupling gels filling the rectum: Correlations with tumor angiogenesis and clinicopathological features. Biomed Res Int. 2014;2014:587806.
    1. Bamber J, Cosgrove D, Dietrich C F et al.EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology. Ultraschall in Med. 2013;34:169–184.
    1. Cosgrove D, Piscaglia F, Bamber J et al.EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: Clinical applications. Ultraschall in Med. 2013;34:238–253.
    1. Rafaelsen S R, Vagn-Hansen C, Sørensen T et al.Ultrasound elastography in patients with rectal cancer treated with chemoradiation. Eur J Radiol. 2013;82:913–917.
    1. Rafaelsen S R, Vagn-Hansen C, Sørensen T et al.Elastography and diffusion-weighted MRI in patients with rectal cancer. Br J Radiol. 2015;88:2.0150294E7.
    1. Waage JE R, Havre R F, Leh S et al.Endorectal elastography in the evaluation of rectal tumors. Colorectal Dis. 2011;13:1130–1137.
    1. Waage JE R, Rafaelsen S R, Borley N R et al.Strain Elastography Evaluation of Rectal Tumors: Inter- and Intraobserver Reproducibility. Ultraschall Med. 2015;36:611–617.
    1. Waage JE R, Leh S, Røsler C et al.Endorectal ulstrasonography, strain elastography and MRI differentiation of rectal adenomas and adenocarcinomas. Colorectal Dis. 2015;17:124–131.
    1. Waage JE R, Bach S P, Pfeffer F et al.Combined endorectal ultrasonography and strain elastography for the staging of early rectal cancer. Colorectal Dis. 2015;17:50–56.
    1. Amin M B, Edge S, Greene F, Byrd D R, Brookland R K, Washington M Ket al.AJCC Cancer Staging Manual 8 th Edition Springer International Publishing; 2017
    1. Beets-Tan RG H, Lambregts DM J, Maas M et al.Magnetic resonance imaging for clinical management of rectal cancer: Updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol. 2018;28:1465–1475.
    1. Puli S R, Bechtold M L, Reddy J B, Choudhary A, Antillon M R, Brugge W R. How good is endoscopic ultrasound in differentiating various T stages of rectal cancer? Meta-analysis and systematic review. Ann Surg Oncol. 2009;16:254–265.
    1. Zhou Y, Shao W, Lu W. Diagnostic value of endorectal ultrasonography for rectal carcinoma: A meta-analysis. J Can Res Ther. 2014;10:319–322.
    1. Fernandez-Esparrach G, Ayuso-Colella J R, Sendino O et al.EUS and magnetic resonance imaging in the staging of rectal cancer: A prospective and comparative study. Gastrointest Endosc. 2011;74:347–354.
    1. Puli S R, Bechtold M L, Reddy J B et al.Can endoscopic ultrasound predict early rectal cancers that can be resected endoscopically? A meta-analysis and systematic review. Dig Dis Sci. 2010;55:1221–1229.
    1. Zorcolo L, Fantola G, Cabras F et al.Preoperative staging of patients with rectal tumors suitable for transanal endoscopic microsurgery (TEM): Comparison of endorectal ultrasound and histopathologic findings. Surg Endosc. 2009;23:1384–1389.
    1. Glancy D G, Pullyblank A M, Thomas M G. The role of colonoscopic endoanal ultrasound scanning (EUS) in selecting patients suitable for resection by transanal endoscopic microsurgery (TEM) Colorectal Dis. 2005;7:148–150.
    1. Carmody B J, Otchy D P. Learning curve of transrectal ultrasound. Dis Colon Rectum. 2000;43:193–197.
    1. Rafaelsen S R, Sorensen T, Jakobsen A et al.Transrectal ultrasonography and magnetic resonance imaging in the staging of rectal cancer. Effect of experience. Scand J Gastroenterol. 2008;43:440–446.
    1. Morris O J, Draganic B, Smith S. Does a learning curve exist in endorectal two-dimensional ultrasound accuracy? Tech Coloproctol. 2011;15:301–311.
    1. Marusch F, Ptok H, Sahm M et al.Endorectal ultrasound in rectal carcinoma – do the literature results really correspond to the realities of routine clinical care? Endoscopy. 2011;43:425–431.
    1. Rafaelsen S R, Kronborg O, Fenger C. Echo pattern of lymph nodes in colorectal cancer: An in vitro study. Br J Radiol. 1992;65:218–220.
    1. Puli S R, Reddy J B, Bechtold M L et al.Accuracy of endoscopic ultrasound to diagnose nodal invasion by rectal cancers: A meta-analysis and systematic review. Ann Surg Oncol. 2009;16:1255–1265.
    1. Li L, Chen S, Wang K et al.Diagnostic value of endorectal ultrasound in preoperative assessment of lymph node involvement in colorectal cancer: A meta-analysis. Asian Pac J Cancer Prev. 2015;16:3485–3491.
    1. Li X T, Sun Y S, Tang L et al.Evaluating local lymph node metastasis with magnetic resonance imaging, endoluminal ultrasound and computed tomography in rectal cancer: A meta-analysis. Colorectal Dis. 2015;17:O129–O135.
    1. Fernández-Esparrach G, Alberghina N, Subtil J C et al.Endoscopic ultrasound-guided fine needle aspiration is highly accurate for the diagnosis of perirectal recurrence of colorectal cancer. Dis Colon Rectum. 2015;58:469–473.
    1. Dumonceau J M, Polkowski M, Larghi A et al.Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2011;43:897–912.
    1. Marone P, de Bellis M, Avallone A et al.Accuracy of endoscopic ultrasound in staging and restaging patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiation. Clin Res Hepatol Gastroenterol. 2011;35:666–670.
    1. Memon S, Lynch A C, Bressel M et al.Systematic review and meta-analysis of the accuracy of MRI and endorectal ultrasound in the restaging and response assessment of rectal cancer following neoadjuvant therapy. Colorectal Dis. 2015;17:748–761.
    1. Mihmanli I, Kantarci F, Dogra V S. Endoanorectal Ultrasonography. Ultrasound Quarterly. 2011;27:87–104.
    1. Lorentzen T, Nolsoe C, Skjoldbye B. Ultrasound-guided drainage of deep pelvic abscesses: Experience with 33 cases. Ultrasound in medicine & biology. 2011;37:723–728.
    1. Christensen A F, Nielsen M B, Engelholm S A, Roed H, Svendsen L B, Christensen H. Three-dimensional anal endosonography may improve staging of anal cancer compared with two-dimensional endosonography. Dis Colon Rectum. 2004;47:341–345.
    1. Christensen A F, Nyhuus B, Nielsen M B. Interobserver and intraobserver variation of two-dimensional and three-dimensional anal endosonography in the evaluation of recurrent anal cancer. Dis Colon Rectum. 2009;52:484–488.
    1. Pezim M E, Spencer R J, Stanhope C R et al.Sphincter repair for fecal incontinence after obstetrical or iatrogenic injury. Dis Colon Rectum. 1987;30:521–525.
    1. Glynne-Jones R, Nilsson P J, Aschele C et al.Anal cancer: ESMO-ESSO-ESTRO clinical practice guidelines for diagnosis, treatment and follow-up. European journal of surgical oncology: The journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2014;40:1165–1176.
    1. Jacopo M. EAUS for anal cancer staging. International Journal of Colorectal Disease. 2011;26:385–386.
    1. Martellucci J, Naldini G, Colosimo C et al.Accuracy of EAUS in the follow-up assessment for squamous cell carcinoma of the anal canal treated with radiochemotherapy. Surgical Endoscopy. 2009;23:1054–1057.
    1. Otto S D, Lee L, Buhr H J et al.Staging anal cancer: Prospective comparison of transanal endoscopic ultrasound and magnetic resonance imaging. Journal of gastrointestinal surgery: Official Journal of the Society for Surgery of the Alimentary Tract. 2009;13:1292–1298.
    1. Parikh J, Shaw A, Grant L A et al.Anal carcinomas: The role of EAUS and magnetic resonance imaging in staging, response evaluation and follow-up. European Radiology. 2011;21:776–785.
    1. Tarantino D, Bernstein M A. EAUS in the staging and management of squamous-cell carcinoma of the anal canal: Potential implications of a new ultrasound staging system. Diseases of the Colon and Rectum. 2002;45:16–22.
    1. Drudi F M, Raffetto N, De Rubeis M et al.ERUS staging and follow-up in patients with anal canal cancer. La Radiologia Medica. 2003;106:329–337.
    1. Giovannini M, Bardou V J, Barclay R et al.Anal carcinoma: Prognostic value of endorectal ultrasound (ERUS). Results of a prospective multicenter study. Endoscopy. 2001;33:231–236.
    1. Sirikurnpiboon S, Phadhana-anake O, Awapittaya B. Comparison of Endoanal Ultrasound with Clinical Diagnosis in Anal Fistula Assessment. J Med Assoc Thai. 2016;99 02:S69–S74.
    1. Toyonaga T, Tanaka Y, Song J F, Katori R et al.Comparison of accuracy of physical examination and endoanal ultrasonography for preoperative assessment in patients with acute and chronic anal fistula. Tech Coloproctol. 2008;12:217–223.
    1. Wiese D M, Beaulieu D, Slaughter J C et al.Use of endoscopic ultrasound to guide adalimumab treatment in perianal crohn’s disease results in faster fistula healing. Inflamm Bowel Dis. 2015;21:1594–1599.
    1. Spradlin N M, Wise P E, Herline A J et al.A randomized prospective trial of endoscopic ultrasound to guide combination medical and surgical treatment for Crohnʼs perianal fistulas. Am J Gastroenterol. 2008;103:2527–2535.
    1. Schwartz D A, White C M, Wise P E, Herline A J. Use of endoscopic ultrasound to guide combination medical and surgical therapy for patients with Crohnʼs perianal fistulas. Inflamm Bowel Dis. 2005;11:727–732.
    1. Ardizzone S, Maconi G, Colombo E et al.Perianal fistulae following infliximab treatment: Clinical and endosonographic outcome. Inflamm Bowel Dis. 2004;10:91–96.
    1. Lahat A, Assulin Y, Beer-Gabel M et al.Endoscopic ultrasound for perianal Crohnʼs disease: Disease and fistula characteristics, and impact on therapy. J Crohns Colitis. 2012;6:311–316.
    1. Parks A G, Gordon P H, Hardcastle J D. A classification of fistula-in-ano. Br J Surg. 1976;63:1–12.
    1. Alabiso M E, Iasiello F, Pellino G et al.3D-EAUS and MRI in the Activity of Anal Fistulas in Crohnʼs Disease. Gastroenterol Res Pract. 2016;2016:1.895694E6.
    1. Siddiqui M R, Ashrafian H, Tozer P et al.A diagnostic accuracy meta-analysis of endoanal ultrasound and MRI for perianal fistula assessment. Dis Colon Rectum. 2012;55:576–585.
    1. Gustafsson U M, Kahvecioglu B, Aström G et al.Endoanal ultrasound or magnetic resonance imaging for preoperative assessment of anal fistula: A comparative study. Colorectal Dis. 2001;3:189–197.
    1. Tepes B, Cerni I. The use of different diagnostic modalities in diagnosing fistula-in-ano. Hepatogastroenterology. 2008;55:912–915.
    1. Tsankov T, Tankova L, Deredjan H et al.Contrast-enhanced endoanal and transperineal sonography in perianal fistulas. Hepatogastroenterology. 2008;55:13–16.
    1. Panes J, Bouhnik Y, Reinisch W et al.Imaging techniques for assessment of inflammatory bowel disease: Joint ECCO and ESGAR evidence-based consensus guidelines. J Crohns Colitis. 2013;7:556–585.
    1. Murad-Regadas S M, Regadas F S, Rodrigues L V et al.The role of 3-dimensional anorectal ultrasonography in the assessment of anterior trans-sphincteric fistula. Dis Colon Rectum. 2010;53:1035–1040.
    1. Garcés-Albir M, García-Botello S A, Esclapez-Valero P et al.Quantifying the extent of fistulotomy. How much sphincter can we safely divide? A three-dimensional endosonographic study. Int J Colorectal Dis. 2012;27:1109–1116.
    1. Ding J H, Bi L X, Zhao K et al.Impact of three-dimensional endoanal ultrasound on the outcome of anal fistula surgery: A prospective cohort study. Colorectal Dis. 2015;17:1104–1112.
    1. Viganò C, Losco A, Caprioli F et al.Incidence and clinical outcomes of intersphincteric abscesses diagnosed by anal ultrasonography in patients with Crohn's disease. Inflamm Bowel Dis. 2011;17:2102–2108.
    1. Brillantino A, Iacobellis F, Di Sarno G et al.Role of tridimensional endoanal ultrasound (3D-EAUS) in the preoperative assessment of perianal sepsis. Int J Colorectal Dis. 2015;30:535–542.
    1. Khati N J, Sondel Lewis N, Frazier A A et al.CT of acute perianal abscesses and infected fistulae: A pictorial essay. Emerg Radiol. 2015;22:329–335.
    1. Albuquerque A. Endoanal ultrasonography in fecal incontinence: Current and future perspectives. World J Gastrointest Endosc. 2015;7:575–581.
    1. Sultan A H, Kamm M A, Talbot I C et al.Anal endosonography for identifying external sphincter defects confirmed histologically. Br J Surg. 1994;81:463–465.
    1. Jeppson P C, Paraiso M F, Jelovsek J E et al.Accuracy of the digital anal examination in women with fecal incontinence. Int Urogynecol J. 2012;23:765–768.
    1. Malouf A J, Williams A B, Halligan S et al.Prospective assessment of accuracy of endoanal MR imaging and endosonography in patients with fecal incontinence. AJR Am J Roentgenol. 2000;175:741–745.
    1. Dobben A C, Terra M P, Slors J F et al.External anal sphincter defects in patients with fecal incontinence: Comparison of endoanal MR imaging and endoanal US. Radiology. 2007;242:463–471.
    1. West R L, Dwarkasing S, Briel J W et al.Can three-dimensional endoanal ultrasonography detect external anal sphincter atrophy? A comparison with endoanal magnetic resonance imaging. Int J Colorectal Dis. 2005;20:328–333.
    1. Cazemier M, Terra M P, Stoker J et al.Atrophy and defects detection of the external anal sphincter: Comparison between three-dimensional anal endosonography and endoanal magnetic resonance imaging. Dis Colon Rectum. 2006;49:20–27.
    1. Dietz H P. Pelvic floor ultrasound: A review. Am J Obstet and Gynecol. 2010;202:321–334.
    1. Nuernberg D, Dietrich CF.Perineale SonographieInKursbuch(Hrsg.)Dt. Ärzteverlag; 2019. in press
    1. Simanowski J H. Perineal ultrasonography of anal and low rectal illnesses - meaningful instrument in the clinical everyday life. Ultraschall Med. 2004;25:108–110.
    1. Rubens D J, Strang J G, Bogineni-Misra S et al.Transperineal sonography of the rectum: Anatomy and pathology revealed by sonography compared with CT and MR imaging. AJR Am J Roentgenol. 1998;170:637–642.
    1. Dietrich C F, Allgayer H, Müller G, Paolucci V, Dietrich C F.Anorektale (ARUS) und endorektale (ERUS) EndosonographieIn:(editor.)Endoskopischer Ultraschall – Eine Einführung Konstanz: Schnetztor Verlag; 2005294–315.
    1. Dietrich C F. Thieme Verlag; 2006. Endoscopic ultrasound. An introduction.
    1. Sailer M, Allgayer H, Dietrich C F, Dietrich C F.Endoanale und endorektale SonographieIn:(editor).Endosonographie Stuttgart: Thieme Verlag; 2008390–413.
    1. Dietrich C F, Barreiros A P, Nuernberg D et al.Perianal ultrasound. Z Gastroenterol. 2008;46:625–630.
    1. Han T I, Kim I O, Kim W S et al.ultrasound identification of the anal sphincter complex and levator ani muscle in neonates: Infracoccygeal approach. Radiology. 2000;217:392–394.
    1. Merz E. Transducer hygiene – an underrated topic? Ultraschall Med. 2005;26:7–8.
    1. Albuquerque A, Pereira E. Current applications of transperineal ultrasound in gastroenterology. World J Radiol. 2016;8:370–377.
    1. Mallouhi A, Bonatti H, Peer S et al.Detection and characterization of perianal inflammatory disease: Accuracy of transperineal combined gray scale and color Doppler sonography. J Ultrasound Med. 2004;23:19–27.
    1. Pistor G. Sonographic visualization of the axial level of the anal sphincters. Preliminary results in children. Ultraschall Med. 2003;24:250–254.
    1. Jurgens J. Perineal sonography: Using time modulated 2D-ultrasound in a freehand 3D technique. Ultraschall Med. 2004;25:54–57.
    1. García Mejido J A, Suárez Serrano C M, Fernández Palacín A et al.Evaluation of levator ani muscle throughout the different stages of labor by transperineal 3D ultrasound. Neurourol Urodyn. 2017;36:1776–1781.
    1. Raimondo D, Youssef A, Mabrouk M et al.Pelvic floor muscle dysfunction at 3D/4D transperinal ultrasound in patients with deep infiltrating endometriosis: A pilot study. Ultrasound Obstet Gynecol. 2017;50:527–532.
    1. Dietz H P, Steensma A B. Posterior compartment prolapse on two-dimensional and three-dimensional pelvic floor ultrasound: The distinction between true rectocele, perineal hypermobility and enterocele. Ultrasound Obstet Gynecol. 2005;26:73–77.
    1. Kołodziejczak M, Santoro G A, Słapa R Z et al.Usefulness of 3D transperineal ultrasound in severe stenosis of the anal canal: Preliminary experience in four cases. Tech Coloproctol. 2014;18:495–501.
    1. Oom D M, West R L, Schouten W R et al.Detection of anal sphincter defects in female patients with fecal incontinence: A comparison of 3-dimensional transperineal ultrasound and 2-dimensional endoanal ultrasound. Dis Colon Rectum. 2012;55:646–652.
    1. Onik G, Barzell W. Transperineal 3D mapping biopsy of the prostate: An essential tool in selecting patients for focal prostate cancer therapy. Urol Oncol. 2008;26:506–510.
    1. Huang W C, Yang S H, Yang J M. Three-dimensional transperineal sonographic characteristics of the anal sphincter complex in nulliparous women. Ultrasound Obstet Gynecol. 2007;30:210–220.
    1. Dietrich C F.Anorectal endosonography ElastographyMedix2008. Supplement54–57.
    1. Allgayer H, Ignee A, Dietrich C F. Endosonographic elastography of the anal sphincter in patients with fecal incontinence. Scand J Gastroenterol. 2010;45:30–38.
    1. Woźniak M M, Pawelec A, Wieczorek A P et al.2D/3D/4D contrast-enhanced voiding urosonography in the diagnosis and monitoring of treatment of vesicoureteral reflux in children - can it replace voiding cystourethrography? J Ultrason. 2013;13:394–407.
    1. Bonatti H, Lugger P, Hechenleitner P et al.Transperineal sonography in anorectal disorders. Ultraschall Med. 2004;25:111–115.
    1. Stewart L K, McGee J, Wilson S R. Transperineal and transvaginal sonography of perianal inflammatory disease. AJR Am J Roentgenol. 2001;177:627–632.
    1. Barreiros A P, Hirche T O, Ignee A et al.Indications and limitations of perineal ultrasound examination. Scand J Gastroenterol. 2010;45:764–765.
    1. Magdeburg B, Fried M, Meyenberger C. Endoscopic ultrasonography in the diagnosis, staging, and follow-up of anal carcinomas. Endoscopy. 1999;31:359–364.
    1. Morris J, Spencer J A, Ambrose N S. MR imaging classification of perianal fistulas and its implications for patient management. Radiographics. 2000;20:623–635.
    1. Sainio P. Fistula-in-ano in a defined population. Incidence and epidemiological aspects. Ann Chir Gynaecol. 1984;73:219–224.
    1. Wedemeyer J, Kirchhoff T, Manns M P, Gebel M J, Bleck J S. Transcutaneous perianal ultrasound (PAUS) for the imaging of fistulas and abscesses in Crohnʼs disease. Z Gastroenterol. 2004;42:1315–1320.
    1. Caprioli F, Losco A, Vigano C, Conte D, Biondetti P, Forzenigo L V et al.Computer-assisted evaluation of perianal fistula activity by means of anal ultrasound in patients with Crohn's disease. Am J Gastroenterol. 2006;101:1551–1558.
    1. American Gastroenterological Association Clinical Practice Committee . American Gastroenterological Association medical position statement: Perianal Crohn’s disease. Gastroenterology. 2003;125:1503–1507.
    1. Maconi G, Ardizzone S, Greco S et al.Transperineal ultrasound in the detection of perianal and rectovaginal fistulae in Crohn’s disease. Am J Gastroenterol. 2007;102:2214–2219.
    1. Maconi G, Tonolini M, Monteleone M et al.Transperineal perineal ultrasound versus magnetic resonance imaging in the assessment of perianal Crohnʼs disease. Inflamm Bowel Dis. 2013;19:2737–2743.
    1. Hwang J Y, Yoon H K, Kim W K et al.Transperineal ultrasonography for evaluation of the perianal fistula and abscess in pediatric Crohn disease: Preliminary study. Ultrasonography. 2014;33:184–190.
    1. Maconi G, Greco M T, Asthana A K. Transperineal Ultrasound for Perianal Fistulas and Abscesses – A Systematic Review and Meta-Analysis. Ultraschall Med. 2017;38:265–272.
    1. Terracciano F, Scalisi G, Bossa F et al.Transperineal ultrasonography: First level exam in IBD patients with perianal disease. Dig Liver Dis. 2016;48:874–879.
    1. Bor R, Farkas K, Bálint A, Szűcs M, Ábrahám S, Milassin Á et al.Prospective comparison of magnetic resonance imaging, transrectal and transperineal sonography, and surgical findings in complicated perianal crohn disease. J Ultrasound Med. 2016;35:2367–2372.
    1. Wright E K, Novak K L, Lu C, Panaccione R, Ghosh S, Wilson S R. Transperineal ultrasonography in perianal Crohn disease: A valuable imaging modality. Can J Gastroenterol Hepatol. 2015;29:445–447.
    1. Bezzio C, Bryant R V, Manes G et al.New horizons in the imaging of perianal Crohnʼs disease: Transperineal ultrasonography. Expert Rev Gastroenterol Hepatol. 2017;28:1–8.
    1. Rasul I, Wlson S R, MacRae H et al.Clinical and radiological response after Infliximab treatment for perianal fistulizing Crohn’s disease. Am J Gastroenterol. 2003;99:82–88.
    1. Bartram C I, Sultan A H. Anal endosonography in faecal incontinence. Gut. 1995;37:4–6.
    1. Bordeianou L, Lee K Y, Rockwood T et al.Anal resting pressures at manometry correlate with the Fecal Incontinence Severity Index and with presence of sphincter defects on ultrasound. Dis Colon Rectum. 2008;51:1010–1014.
    1. Andrews V, Sultan A H, Thakar R et al.Occult anal sphincter injuries – myth or reality? BJOG. 2006;113:195–200.
    1. Wheeler T L, Richter H E. Delivery method, anal sphincter tears and fecal incontinence: New information on a persistent problem. Curr Opin Obstet Gynecol. 2007;19:474–479.
    1. Saranovic D, Krivokapic Z, Masulovic D et al.Endoanal ultrasonography in establishing the diagnosis of fecal incontinence. Acta Chir Iugosl. 2007;54:159–162.
    1. Beer-Gabel M, Assoulin Y, Amitai M et al.A comparison of dynamic transperineal ultrasound (DTP-US) with dynamic evacuation proctography (DEP) in the diagnosis of cul de sac hernia (enterocele) in patients with evacuatory dysfunction. Int J Colorectal Dis. 2008;23:513–519.
    1. Cornelia L, Stephan B, Michel B, Antoine W, Felix K. Trans-perineal versus endo-anal ultrasound in the detection of anal sphincter tears. Eur J Obstet Gynecol Reprod Biol. 2002;103:79–82.
    1. Martellucci J, Naldini G. Clinical relevance of transperineal ultrasound compared with evacuation proctography for the evaluation of patients with obstructed defaecation. Colorectal Dis. 2011;13:1167–1172.
    1. Roos A M, Abdool Z, Sultan A H, Thakar R. The diagnostic accuracy of endovaginal and transperineal ultrasound for detecting anal sphincter defects: The PREDICT study. Clin Radiol. 2011;66:597–604.
    1. Son J K, Taylor G A. Transperineal ultrasonography. Pediatr Radiol. 2014;44:193–201.
    1. Shek K L, Guzman-Rojas R, Dietz H P. Residual defects of the external anal sphincter following primary repair: An observational study using transperineal ultrasound. Ultrasound Obstet Gynecol. 2014;44:704–709.
    1. Valsky D V, Cohen S M, Lipschuetz M et al.Three-dimensional transperineal ultrasound findings associated with anal incontinence after intrapartum sphincter tears in primiparous women. Ultrasound Obstet Gynecol. 2012;39:83–90.
    1. Weemhoff M, Kluivers K B, Govaert B et al.Transperineal ultrasound compared to evacuation proctography for diagnosing enteroceles and intussusceptions. Int J Colorectal Dis. 2013;28:359–363.
    1. Roche B, Deleaval J, Fransioli A et al.Comparison of transanal and external perineal ultrasonography. Eur Radiol. 2001;11:1165–1170.
    1. Bader W, Tunn R, Viereck V et al.Introital and perineal sonography in diagnosing stress urinary incontinence - possible clinical applications. Ultraschall Med. 2004;25:181–190.
    1. Han T I, Kim I O, Kim W S. Imperforate anus: Ultrasound determination of the type with infracoccygeal approach. Radiology. 2003;228:226–229.
    1. Kim I O, Han T I, Kim W S et al.Transperineal ultrasonography in imperforate anus: Identification of the internal fistula. J Ultrasound Med. 2000;19:211–216.
    1. Zbar A P, Murison R. Transperineal ultrasound in the assessment of haemorrhoids and haemorrhoidectomy: A pilot study. Tech Coloproctol. 2010;14:175–179.
    1. Sperling D C, Needleman L, Eschelman D J et al.Deep pelvic abscesses: Transperineal US-guided drainage. Radiology. 1998;208:111–115.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere