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Imaging Atlas of the Pelvic Floor and Anorectal Diseases

Mario Pescatori MD, FRCS, EBSQ,
F. Sérgio P. Regadas MD, PhD,
Sthela M. Murad Regadas MD, PhD,
Andrew P. Zbar MD (Lond) MBBS, FRCS (Edin), FRCS (Gen), FRACS, FSICCR
ISBN: 978-88-470-0808-3 (Print)
978-88-470-0809-0 (Online)

Palavras chave: Coloproctologia

Ano: 2008



Exciting technical advances in US, CT, and MRI over the past decade have greatly enhanced the challenging task of investigating intestinal, pelvic floor, and anorectal function and dysfunction. The goal of Imaging Atlas of the Pelvic Floor and Anorectal Diseases, edited and authored by internationally respected experts in the field, is to clearly and precisely present indications, techniques, limitations, sources of errors, and pitfalls of these imaging modalities. The concise text expertly describes the abundant, high-quality images that show the normal anorectal anatomy as well as the pathological appearance of the all-too-common large-bowel and pelvic floor functional diseases. The use of radiopaque markers in diagnosing colonic inertia; defecography, 3D US, and MRI in investigating obstructed defecation; 3D US and MRI in differentiating between benign and malignant anorectal neoplasms; CT and MRI in assessing pelviperineal anatomy and identifying pelvic tumors and inflammatory processes; and 2D and 3D US in determining appropriate treatment for fecal incontinence are discussed in depth. One of the atlas’s strongest points is illustrating the use of 3D anorectal US with automatic scan in identifying complex anal fistula tracks, staging benign and malignant tumors, and postradiotherapy follow-up. Of particular importance is the description of novel dynamic techniques, such as dynamic transperineal US, in assessing pelvic floor functional diseases. Also importantly, this atlas demonstrates the value of a “”team approach”” between colorectal surgeons and radiologists for solving complex clinical disorders of the anorectum and pelvic floor.


Imaging is now central to the investigation and management of anorectal and pelvic floor disorders. This has been brought about by technical developments in imaging, notably, three-dimensional ultrasound and magnetic resonance imaging (MRI), which allow high anatomical resolution and tissue differentiation to be presented in a most usable fashion. Three-dimensional endosonography in anorectal conditions and MRI in anal fistula are two obvious developments, but there are others, with dynamic studies of the pelvic floor using both ultrasound and MRI coming to the fore. This atlas provides an easy way to gain a detailed understanding of imaging in this field. The atlas is divided into four sections covering the basic anatomy, anal/perianal disease, rectal/perirectal disease and functional assessment. One of the difficulties with developing an atlas is to strike the right balance between text and images. Too much text and it is not an atlas; too little text and the images may not be understood. The editors of this atlas are to be congratulated on achieving an appropriate balance. The images are all that one expects from an atlas, and the diagrams are excellent. The commentaries at the end of invited chapters are a valuable addition, placing what are relatively short, focussed chapters into context. They add balance and depth to the work and are well worth reading. The range covered in this atlas is extensive and includes all the coloproctologist would expect to encounter. Anorectal cancer is included, as are other primary pelvic tumours and metastatic diseases. Again, this increases the breadth of the work, as when working in this field it is important to know about tumours in other related systems. I am pleased that colonic transit time is included, as this is such an integral part of the investigation of constipation and pelvic floor disorders. The chapters on ultrasound, which more directly address clinicians, are detailed, practical and well illustrated. This is a well-laid-out atlas, with several imaginative innovations. It is readily accessible and will be most helpful to all health care providers in this field of expertise.

London, June 2008
Professor Clive I. Bartram, FRCS, FRCP, FRCR
Consultant Radiologist Princess Grace Hospital London, UK


The field of coloproctology is an increasingly complex one. Knowledge of both benign and malignant anorectal diseases has expanded dramatically, and with this growth, a new array of available treatment options has emerged. In addition, continued steady progress in the study of pelvic floor disorders has led to an ever-broadening range of available therapies. Moreover, treatment of anorectal and pelvic floor disorders, be they organic or functional, is increasingly informed by the anticipated functional consequences of the proposed therapy. Gone are the days when every fissure was treated by sphincterotomy, fistula by fistulotomy, or cancer by radical surgery (or radical surgery alone). In order to optimally treat these difficult problems, the surgeon must have the most accurate possible preoperative information, including – especially – imaging. Fortunately, the increasing availability of new imaging techniques, coupled with a dramatic improvement in image quality, is now positioned to provide exactly this information. However, as with many opportunities, this one comes with a challenge. Colorectal surgeons need to know which test to perform when, and how to interpret the results. Radiologists need to understand the fine points of functional anatomy and the clinical relevance of specific findings. Much is written advocating a “team approach” to complex clinical problems, and the concept applies particularly well to disorders of the anorectum and pelvic floor. Imaging Atlas of the Pelvic Floor and Anorectal Diseases fills an important void at the interdisciplinary juncture. There is much to recommend this book. The authors are internationally recognized authorities, many of them pioneers in their specific subspecialty fields. The book is practical, logically organized, and clearly written. The illustrations and diagrams are sharp, well labeled, and easy to understand. At the end of several chapters, the editors provide helpful commentaries that emphasize key issues and provide the appropriate clinical context. I congratulate Drs. Pescatori, Regadas, Murad Regadas, and Zbar on this outstanding work, which can only serve to advance the dialog between specialties and care of affected patients.

Minneapolis, June 2008 Robert D. Madoff, MD
Stanley M. Goldberg, MD Professor of Surgery Chief, Division of Colon and Rectal Surgery University of Minnesota Minneapolis, MN, USA


SECTION I Normal Anal Canal and Rectum Anatomy

CHAPTER 1 Two-dimensional Ultrasonography of Pelvic Floor and Anorectal Anatomy
CHAPTER 2 Three-dimensional Ultrasonography of Pelvic Floor and Anorectal Anatomy
CHAPTER 3 Transperineal Ultrasonography of Pelvic Floor and Anorectal Anatomy: Technique and Images
CHAPTER 4 Computed Tomography and Magnetic Resonance Imaging of Pelviperineal Anatomy

SECTION II Anal and Perianal Diseases

CHAPTER 5 Two- and Three-dimensional Ultrasonography of Anatomic Defects in Fecal Incontinence
CHAPTER 6 Transperineal Ultrasonography of Anatomic Defects in Fecal Incontinence
CHAPTER 7 Magnetic Resonance Imaging of Anatomic Defects in Fecal Incontinence
CHAPTER 8 Two- and Three-dimensional Ultrasonography in Abscess and Anal Fistula
CHAPTER 9 Computed Tomography and Magnetic Resonance Imaging in Abscess and Anal Fistula
CHAPTER 10 Staging and Follow-up of Anal Canal Neoplasms with 2- and 3-D
CHAPTER 11 Staging and Follow-up of Anal Canal Neoplasm with Magnetic Resonance

SECTION III Rectal and Perirectal Diseases

CHAPTER 12 Two- and Three-dimensional Ultrasonography in Benign and Malignant Rectal Neoplasms
CHAPTER 13 Magnetic Resonance Imaging in Benign and Malignant Rectal Neoplasms
CHAPTER 14 Pelvic Primary and Metastatic Tumors: Computed Tomography Images
CHAPTER 15 Magnetic Resonance Imaging of Pelvic Primary and Metastatic Tumors
CHAPTER 16 The use of PET/PET CT in the Management of Colorectal Cancer
CHAPTER 17 2- and 3-D Ultrasonography of Endometriosis, Pelvic Cyst, Rectal Solitary Ulcer, Muscle Hypertrophy, Rare Neoplasms

SECTION IV Large Bowel and Pelvic Floor Functional Assessment: Imaging Indications and Technical Principles

CHAPTER 18 Radiography and Radiopaque Markers in Colonic Transit-Time Studies
CHAPTER 19 Cinedefecography in Functional Pelvic Floor Disorders
CHAPTER 20 Dynamic Transperineal
CHAPTER 21 Two-dimensional Introital Sonography in Patterns of Anorectal
CHAPTER 22 Dynamic Two- and Three-dimensional Ultrasonography: Echodefecography
CHAPTER 23 Dynamic Magnetic Resonance Defecography

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