Kirby G, Zarifa I, Elkassaby A, Delacy P, Raghavan A, MacDonald C. Systematic review of ultrasound and MRI prediction of spinal cord anomalies in children with anorectal malformations: what a pediatric urologist writing a protocol needs to know.
WORLD JOURNAL OF PEDIATRIC SURGERY 2025;
8:e000978. [PMID:
40196182 PMCID:
PMC11973764 DOI:
10.1136/wjps-2024-000978]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Accepted: 03/10/2025] [Indexed: 04/09/2025] Open
Abstract
Background
Anorectal malformation (ARM) have a high association with spinal cord anomaly (SCA) impacting bladder and bowel function. This study aims to report the diagnostic accuracy of ultrasound (US) and MRI to detect SCA in children with ARM.
Method
A systematic review was performed as per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidance. Search terms used were broadened in three consecutive searches to find papers investigating outcomes from spinal imaging in ARM, with four author search validation. Study quality was assessed as per Quadas 2 score. Meta-analysis comparing US diagnosis to MRI findings was performed using random effects model, including only clinically relevant SCA and considering children who did not develop negative outcomes as a true negative.
Results
Eight studies were included, six reporting US outcomes, and two MRI. All studies but one were retrospective studies. Overall, the included studies were applicable, but all suffered risk of bias with incomplete and non-protocolized follow-up. Pooled analysis for MRI compared with surgery found a sensitivity of 97% and a specificity of 94%, with one false positive and one false negative in an 8-month-old baby. When clinically relevant diagnoses were extracted and meta-analysis performed, a sensitivity of 33% and a specificity of 87% were found for infant US diagnosis of SCA.
Conclusion
The normal US spine in early infancy does not have diagnostic weight. A positive early scan will allow you to stream into active surveillance. Mandated MRI of infants will depend on the local approach to prophylactic de-tethering surgery.
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