MR-FLIP: A new method that combines FLIP with anatomical information for the spatial compliance assessment of the anal sphincter muscles.

Brusa, Tobia; Abler, Daniel; Tutuian, Radu; Studer, Peter; Fattorini, Elisa; Gingert, Christian; Heverhagen, Johannes; Brügger, Lukas; Büchler, Philippe (2017). MR-FLIP: A new method that combines FLIP with anatomical information for the spatial compliance assessment of the anal sphincter muscles. Colorectal disease, 19(8), pp. 764-771. Wiley 10.1111/codi.13588

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INTRODUCTION Continence results from a complex interplay between anal canal (AC) muscles and sensory-motor feedback mechanisms. The AC's passive ability to withstand opening pressure - its compliance - has recently been shown to correlate with continence. Functional lumen imaging probe (FLIP) is used to assess AC compliance, although it provides no anatomical information. Therefore, compliance assessment of specific anatomical structures has not been possible, and the anatomical position of critical functional zones remains unknown. In addition, FLIP assumes a circular orifice cross-section, which has not been shown for the AC. To address those shortcomings, a technique combining FLIP with a medical imaging modality is needed. METHOD We implemented a new research method (MR-FLIP) that combines FLIP with MR-imaging. Twenty healthy volunteers underwent MR-FLIP and conventional FLIP assessment. MR-FLIP was validated by comparison with FLIP results. Anatomical markers were identified, and the cross-sectional shape of the orifice was investigated. RESULTS MR-FLIP provides compliance measurements identical to those obtained by conventional FLIP. Anatomical analysis revealed that the least compliant AC zone was located at the proximal end of the external anal sphincter. The AC cross-sectional shape was found to deviate only slightly from circularity in healthy volunteers. CONCLUSION The proposed method was equivalent to classical FLIP. It establishes for the first time a direct mapping between local tissue compliance and anatomical structure, which is key for gaining novel insights into (in)continence. In addition, MR-FLIP provides a tool for better understanding conventional FLIP measurements in the AC by quantifying its limitations and assumptions. This article is protected by copyright. All rights reserved.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute for Surgical Technology & Biomechanics ISTB
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Viszeralchirurgie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Viszeralchirurgie

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Visceral Surgery
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Radiologie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Radiologie

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Gastroenterology

Graduate School:

Graduate School for Cellular and Biomedical Sciences (GCB)

UniBE Contributor:

Brusa, Tobia; Abler, Daniel; Tutuian, Radu; Studer, Peter; Heverhagen, Johannes; Brügger, Lukas and Büchler, Philippe

Subjects:

500 Science > 570 Life sciences; biology
600 Technology > 610 Medicine & health

ISSN:

1463-1318

Publisher:

Wiley

Language:

English

Submitter:

Lilian Karin Smith-Wirth

Date Deposited:

08 Feb 2017 09:25

Last Modified:

21 Dec 2017 02:30

Publisher DOI:

10.1111/codi.13588

PubMed ID:

27997766

BORIS DOI:

10.7892/boris.93422

URI:

https://boris.unibe.ch/id/eprint/93422

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