IMAGING OF ANORECTAL DISEASES

Imaging of Anorectal Diseases Review published in: American Journal of Roentgenology: 171, October 1998 Reviewed by Dean D. T. Maglinte Methodist Hospital of Indiana Indiana School of Medicine With the emergence of endoanal sonography and the continuous development of MR imaging in anorectal disorders, the need to describe these advances in a concise yet comprehensive text is apparent. This effort was undertaken by Dr Hussain and four contributors who are acknowledged authorities in their respective fields. The book is a development of Dr Hussain's thesis which was completed at the Dept of Radiology, University Hospital, Rotterdam, the Netherlands. This is an easy-to-read book from the first to the last page. It contains eight chapters. The illustrations are outstanding in all chapters, especially the six chapters written by Dr Hussain. In those six chapters, each normal or abnormal entity has the corresponding sonogram, an MR image, a coloured schematic diagram and the histologic counterpart when needed. This is the outstanding feature of the book that distinguishes it from other texts in this field. This collection of illustration alone justifies the price of this small book. The first chapter on anorectal anatomy is required reading for those involved in imaging of the anorectum. The controversies about the anatomic descriptions of the external anal sphincter are discussed. The various imaging techniques are described in chapter 2. An excellent description of the various normal imaging findings follows in chapter 3. This chapter is notable for its discussion of how MR imaging findings in vivo differ from anatomic descriptions. The last five chapters are clinical chapters devoted to anorectal diseases. One chapter is devoted to the role of proctography. Three of the chapters in this group are outstanding: Hussain's chapters on anal fistulas and fecal incontinence and the chapter by Somer and O'Donovan in perianal Crohn's disease. The role of dynamic rectal examination (proctography) for the investigation of functional anorectal disorders is described by an acknowledged expert on the subject. Although the paragraph on future developments in this chapter suggests the additional use of MR imaging for evaluating the anterior and middle compartments, the author failed to mention that dynamic cystoproctography, has been in use in some institutions for many years for global assessment of all pelvic floor compartments. Nonetheless this is a minor criticism that does not detract from the informative description of proctographic findings of anorectal diseases. Imaging of Anorectal Diseases is a well organised, superbly illustrated imaging textbook of anorectal diseases. I am not aware of a comparable text on imaging of these diseases. For male patients the text can stand alone as the imaging reference. For female patients, this book is an excellent complement to Benson's Female Pelvic Floor Disorders: Investigation and Management (1992 Norton Medical Textbook, New York) a textbook that has championed the global assessment of pelvic floor dysfunction. The authors should be congratulated for bringing into one text all the current advances in imaging of disorders that significantly affect the wellness and quality of life of many patients. They have achieved quite well their stated purpose. I highly recommend this book to all radiologists, gynaecologists, urologists, gastroenterologists and colorectal surgeons involved in the study of anorectal or pelvic floor disorders. Oncologists and students of anatomy of the anorectum will also benefit from this book. It represents a valuable addition to the imaging literature. My compliments to Dr Hussain. Imaging of Anorectal Disease Review published in: Radiology, September 1998 Reviewed by James M. Messmer, MD Imaging of Anorectal Disease is intended to help radiologists and surgeons understand and perform the new techniques available in the imaging of the anus and rectum. The author is well known as a leader in this area and has put together a short but fairly comprehensive book. The book contains an initial discussion of normal anatomy and normal imaging findings with a separate chapter on ultrasonography (US) and magnetic resonance (MR) imaging. The remainder of the book covers specific diseases and topics including anal fistulas, perianal Crohn disease, fecal incontinence, functional abnormalities and anorectal tumours. The organisation of the text is sound and the author has made liberal use of illustrations, many of which have accompanying anatomic correlation. Particularly helpful is the use of side-by-side comparisons of MR and US images. A guide at the beginning of the book helps readers grasp the numerous colour schematics, which are visually striking but difficult to use. The overall quality of all the illustrations is excellent. Some radiologists may find the decision of the physics of the imaging techniques superfluous, while surgeons, the other intended audience, may find it too complicated for practical use. The specific descriptions of normal anatomy are difficult to follow, but this may simply reflect the anatomic complexity of this region of the body. The brief but thorough description of the history of various investigators' studies of this region is a distinctive contribution. The section dealing with specific diseases and clinical problems provides excellent illustrations and many points of practical value. Most interpreters of images of the anorectal area will find Imaging of Anorectal Disease an exceptional, solid reference textbook. Imaging of Anorectal Disease Review published in: Abdominal Imaging 23: 344 (1998) Reviewed by Richard M. Gore, MD Evanston Hospital Northwestern University Medical School Evanston, IL, USA The evaluation of functional and anatomic disorders of the anorectum has been revolutionised by recent developments in transrectal ultrasound and MR, and with refinements in evacuation proctography. In an attempt to cover this important topic, this book serves as part atlas, part text, and part how-to guide. The book begins with a brief chapter on anorectal anatomy. The next two chapters discuss the technique and normal imaging findings of transrectal ultrasound and endoanal MR. This is followed by one chapter addressing anal fistulae and another perianal Crohn disease. The endoanal MR and ultrasound findings of fecal incontinence are then presented. A chapter devoted to evacuation proctography and functional anorectal abnormalities follows. The book concludes with the endoluminal MR and ultrasound staging of anorectal tumours. The strength of the book lies in its superb endoanal images and line drawings. The weakness of the book relates to the fact that it focuses almost exclusively on the transrectal approach to imaging the anorectum. Too little material relating to MR imaging of the anorectum using surface coils and intraluminal contrast or air is presented. Also absent is a discussion of transvaginal and transperineal sonographic assessment of Crohn disease and fistulae. The chapter of evacuation proctography stresses the need to opacify the vagina and small bowel during these studies, but it does not mention or illustrate the importance of bladder opacification in evaluating pelvic floor abnormalities. Finally no CT images are included. This book does a splendid job in discussing endoanal MR and ultrasound and will be of interest to physicians who perform these exams. This parochial approach, however, falls short of providing comprehensive coverage of the imaging of anorectal disease. Imaging of Anorectal Disease Review published in: Canadian Association of Radiologists Journal, Vol. 49; No.6: December 1998 Reviewed by Stephen J. Shekan MB, FFRRCSI Department of Radiology McMaster University Medical Centre Hamilton, Ontario, Canada This volume fills an important void in the imaging literature by describing both existing and newer techniques for imaging the anorectal region. The book is divided into 8 chapters. The earlier chapters describe anorectal anatomy from both the classic anatomic standpoint and an in vivo imaging perspective. There is a brief description of ultrasonography and magnetic resonance (MR) physics and equipment, targeted primarily at nonradiologists but also very useful for a radiologist setting up or expanding an anorectal imaging service. The rest of the book covers endoluminal imaging of anal fistulae, imaging of Crohn's disease using a body coil, fecal incontinence, functional anorectal abnormalities (essentially defecography) and anorectal tumours. The chapter on normal imaging findings is, appropriately, the longest in the book with detailed descriptions of ultrasonographic and multiplanar MR appearances. Excellent colour drawings accompany most of the normal and pathologic images, which simplifies interpretation. One particularly attractive feature is the use of consistent colour coding for various structures throughout the book, which avoids the need for excessive diagram labelling. Although the image quality is mainly excellent, in some instances, the abnormality shown in the line drawing is not immediately recognisable in the accompanying image. A significant attribute of the book is its length - at 148 pages, it can be read in a weekend - yet it comprehensively covers its subject. The material contained in this book has not previously been available in one volume. The author's extensive experience in this area, particularly with the newer modalities such as endoanal MR imaging and ultrasonography, makes this an authoritative and readable work that I strongly recommend to radiologists and surgeons involved in the management of diseases of the anorectum.