Contrast‐Enhanced Ultrasound in Children with Anorectal Malformations
Hritika Rathi, Anmol Bhatia, Nitin James Peters, Kushaljit Singh Sodhi, Muneer Abas Malik, Akshay Kumar SaxenaObjectives
To explore the utility of contrast‐enhanced ultrasono‐distal cologram (CE‐US‐DC) as a radiation‐free modality to detect fistulae with genitourinary tract in children with anorectal malformation (ARM), compared with fluoroscopic distal cologram (F‐DC) as the gold standard.
Methods
In this IRB‐approved prospective study, 50 children (up to 2 years of age) with ARMs were enrolled over an 18‐month period (January 2024–June 2025). All children underwent F‐DC followed by CE‐US‐DC in the same sitting. The type of fistula and the level of communication on CE‐US‐DC were recorded and compared with those on F‐DC.
Results
Rectourethral, rectovesical, rectoperineal, and rectovaginal fistulas were seen in 27/50 (54%), 1/50 (2%), 11/50 (22%), and 4/50 (8%) children, respectively, on F‐DC. No fistula was seen in 7/50 (14%) children on F‐DC. CE‐US‐DC demonstrated 100% sensitivity and 100% negative predictive value. One fistula detected on CE‐US‐DC yielded a specificity of 85.71% and a positive predictive value of 97.73%. CE‐US‐DC showed an overall accuracy of 98%. Cohen's Kappa analysis indicated perfect agreement (κ = 1.0) for most fistula types and strong agreement for rectovaginal types (κ = 0.878). ROC curve analysis showed an AUC value of 1.0 for rectourethral, rectoperineal, and rectovesical fistula, and 0.989 for rectovaginal fistula.
Conclusion
CE‐US‐DC demonstrated excellent diagnostic accuracy and almost perfect agreement with F‐DC, indicating high reliability and reproducibility in detecting fistulae with genitourinary tract in children with ARM. CE‐US‐DC has great potential as an attractive radiation‐free modality in the pre‐operative workup of children with ARM.