Journal of pediatric surgery · 2026
Contrast-enhanced Colonosonography in AnoRectal malformations (CoCo-ARM) study.
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Westwood Esther, Bhardwaj Andrea, Lloyd Clare, Urquia Arlen, Jogeesvaran Haran, Thakkar Hemanshoo
Аннотация
INTRODUCTION: Fluoroscopic colostography (FC) is the gold-standard modality to plan definitive surgery in anorectal malformation (ARM). Contrast-enhanced colosonography (CeCS) can be used in this context. We conducted a prospective, single-centre study comparing the accuracy of CeCS with FC.
METHODS: Male patients with ARM awaiting reconstructive surgery were recruited during a 12-month period. CeCS using SonoVue were performed and reported contemporaneously by two investigating consultant radiologists. FCs were performed departmentally. All studies were reported as anonymised, unlinked studies by a third blinded consultant. The anonymised studies were reported with a Likert score to denote confidence in the findings. Findings were compared between the two imaging techniques and at operation.
RESULTS: 11 patients were included. There was agreement in 8/11 (73%) patients between the two modalities. Beaking was seen at FC without a clear fistula in 2 cases, but was demonstrated clearly on CeCS. In the eleventh case, FC demonstrated a potential perineal fistula; there was poor filling of the distal limb using initial CeCS. This study was repeated under GA combined with cystoscopy, clearly identifying a recto-prostatic fistula. There was agreement in 100% of cases during blinded review of the CeCS with a mean Likert rating of 1.6 (SD = 0.64). In 10/10 (100%) of those who have undergone reconstructive surgery, CeCS findings were consistent with operative findings.
CONCLUSIONS: CeCS is equivalent, if not superior to, FC in accurately identifying the fistular anatomy in males with anorectal malformations. Studies can be reviewed and reported with a high degree of diagnostic confidence.
METHODS: Male patients with ARM awaiting reconstructive surgery were recruited during a 12-month period. CeCS using SonoVue were performed and reported contemporaneously by two investigating consultant radiologists. FCs were performed departmentally. All studies were reported as anonymised, unlinked studies by a third blinded consultant. The anonymised studies were reported with a Likert score to denote confidence in the findings. Findings were compared between the two imaging techniques and at operation.
RESULTS: 11 patients were included. There was agreement in 8/11 (73%) patients between the two modalities. Beaking was seen at FC without a clear fistula in 2 cases, but was demonstrated clearly on CeCS. In the eleventh case, FC demonstrated a potential perineal fistula; there was poor filling of the distal limb using initial CeCS. This study was repeated under GA combined with cystoscopy, clearly identifying a recto-prostatic fistula. There was agreement in 100% of cases during blinded review of the CeCS with a mean Likert rating of 1.6 (SD = 0.64). In 10/10 (100%) of those who have undergone reconstructive surgery, CeCS findings were consistent with operative findings.
CONCLUSIONS: CeCS is equivalent, if not superior to, FC in accurately identifying the fistular anatomy in males with anorectal malformations. Studies can be reviewed and reported with a high degree of diagnostic confidence.