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Sonographic appearance of anal cushions of hemorrhoids

AIM: To evaluate the diagnostic value of different sonographic methods in hemorrhoids. METHODS: Forty-two healthy volunteers and sixty-two patients with grades I-IV hemorrhoids received two different sonographic examinations from January 2013 to January 2016 at the First and Second Hospitals of Xinj...

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Autores principales: Aimaiti, Adilijiang, A Ba Bai Ke Re, Ma Mu Ti Jiang, Ibrahim, Irshat, Chen, Hui, Tuerdi, Maimaitituerxun, Mayinuer
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5449423/
https://www.ncbi.nlm.nih.gov/pubmed/28611519
http://dx.doi.org/10.3748/wjg.v23.i20.3664
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author Aimaiti, Adilijiang
A Ba Bai Ke Re, Ma Mu Ti Jiang
Ibrahim, Irshat
Chen, Hui
Tuerdi, Maimaitituerxun
Mayinuer,
author_facet Aimaiti, Adilijiang
A Ba Bai Ke Re, Ma Mu Ti Jiang
Ibrahim, Irshat
Chen, Hui
Tuerdi, Maimaitituerxun
Mayinuer,
author_sort Aimaiti, Adilijiang
collection PubMed
description AIM: To evaluate the diagnostic value of different sonographic methods in hemorrhoids. METHODS: Forty-two healthy volunteers and sixty-two patients with grades I-IV hemorrhoids received two different sonographic examinations from January 2013 to January 2016 at the First and Second Hospitals of Xinjiang Medical University in a prospective way. We analyzed the ultrasonographic findings of these participants and evaluated the outcomes. Resected grades III and IV hemorrhoid tissues were pathologically examined. The concordance of ultrasonographic results with pathology results was assessed with the Cohen’s kappa coefficient. RESULTS: All healthy volunteers and all patients had no particular complications related to sonography. There were no statistically significant differences between the participants regarding age (P = 0.5919), gender (P = 0.4183), and persistent symptoms (P > 0.8692). All healthy control participants had no special findings. However, 30 patients with hemorrhoids showed blood signals around the dentate line on ultrasonography. When grades I and II hemorrhoids were analyzed, there were no significant differences between transrectal ultrasound (TRUS), transperianal ultrasound (TPUS), and transvaginal ultrasound (TVUS) (P > 0.05). Grades III and IV hemorrhoids revealed blood flow with different directions which could be observed as a “mosaic pattern”. In patients with grades III and IV hemorrhoids, the number of patients with “mosaic pattern” as revealed by TRUS, TPUS and TVUS was 22, 12, and 4, respectively. Patients with grades III and IV disease presented with a pathologically abnormal cushion which usually appeared as a “mosaic pattern” in TPUS and an arteriovenous fistula in pathology. Subepithelial vessels of resected grades III and IV hemorrhoid tissues were manifested by obvious structural impairment and retrograde and ruptured changes of internal elastic lamina. Some parts of the Trietz’s muscle showed hypertrophy and distortion. Arteriovenous fistulas and venous dilatation were obvious in the anal cushion of hemorhoidal tissues. After pathological results with arteriovenous fistulas were taken as the standard reference, we evaluated the compatibility between the two methods according to the Cohen’s kappa co-efficiency calculation. The compatibility (Cohein kappa co-efficiency value) between “mosaic pattern” in the TPUS and arteriovenous fistula in pathology was very good (ĸ = 0.8939). When compared between different groups, TRUS presented the advantage that the mosaic pattern could be confirmed in more patients, especially for group A. There was a statistical difference when comparing group A with group B or C (P < 0.05 for both). There were obvious statistical differences between group A and group B with regard to the vessel diameter and blood flow velocity measured by TRUS (P < 0.05). CONCLUSION: Patients with grades III and IV hemorrhoids present with a pathologically abnormal cushion which usually appears as a “mosaic pattern” in sonography, which is in accord with an arteriovenous fistula in pathology. There are clearly different hemorrhoid structures shown by sonography. “Mosaic pattern” may be a parameter for surgical indication of grades III and IV hemorrhoids.
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spelling pubmed-54494232017-06-13 Sonographic appearance of anal cushions of hemorrhoids Aimaiti, Adilijiang A Ba Bai Ke Re, Ma Mu Ti Jiang Ibrahim, Irshat Chen, Hui Tuerdi, Maimaitituerxun Mayinuer, World J Gastroenterol Basic Study AIM: To evaluate the diagnostic value of different sonographic methods in hemorrhoids. METHODS: Forty-two healthy volunteers and sixty-two patients with grades I-IV hemorrhoids received two different sonographic examinations from January 2013 to January 2016 at the First and Second Hospitals of Xinjiang Medical University in a prospective way. We analyzed the ultrasonographic findings of these participants and evaluated the outcomes. Resected grades III and IV hemorrhoid tissues were pathologically examined. The concordance of ultrasonographic results with pathology results was assessed with the Cohen’s kappa coefficient. RESULTS: All healthy volunteers and all patients had no particular complications related to sonography. There were no statistically significant differences between the participants regarding age (P = 0.5919), gender (P = 0.4183), and persistent symptoms (P > 0.8692). All healthy control participants had no special findings. However, 30 patients with hemorrhoids showed blood signals around the dentate line on ultrasonography. When grades I and II hemorrhoids were analyzed, there were no significant differences between transrectal ultrasound (TRUS), transperianal ultrasound (TPUS), and transvaginal ultrasound (TVUS) (P > 0.05). Grades III and IV hemorrhoids revealed blood flow with different directions which could be observed as a “mosaic pattern”. In patients with grades III and IV hemorrhoids, the number of patients with “mosaic pattern” as revealed by TRUS, TPUS and TVUS was 22, 12, and 4, respectively. Patients with grades III and IV disease presented with a pathologically abnormal cushion which usually appeared as a “mosaic pattern” in TPUS and an arteriovenous fistula in pathology. Subepithelial vessels of resected grades III and IV hemorrhoid tissues were manifested by obvious structural impairment and retrograde and ruptured changes of internal elastic lamina. Some parts of the Trietz’s muscle showed hypertrophy and distortion. Arteriovenous fistulas and venous dilatation were obvious in the anal cushion of hemorhoidal tissues. After pathological results with arteriovenous fistulas were taken as the standard reference, we evaluated the compatibility between the two methods according to the Cohen’s kappa co-efficiency calculation. The compatibility (Cohein kappa co-efficiency value) between “mosaic pattern” in the TPUS and arteriovenous fistula in pathology was very good (ĸ = 0.8939). When compared between different groups, TRUS presented the advantage that the mosaic pattern could be confirmed in more patients, especially for group A. There was a statistical difference when comparing group A with group B or C (P < 0.05 for both). There were obvious statistical differences between group A and group B with regard to the vessel diameter and blood flow velocity measured by TRUS (P < 0.05). CONCLUSION: Patients with grades III and IV hemorrhoids present with a pathologically abnormal cushion which usually appears as a “mosaic pattern” in sonography, which is in accord with an arteriovenous fistula in pathology. There are clearly different hemorrhoid structures shown by sonography. “Mosaic pattern” may be a parameter for surgical indication of grades III and IV hemorrhoids. Baishideng Publishing Group Inc 2017-05-28 2017-05-28 /pmc/articles/PMC5449423/ /pubmed/28611519 http://dx.doi.org/10.3748/wjg.v23.i20.3664 Text en ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Basic Study
Aimaiti, Adilijiang
A Ba Bai Ke Re, Ma Mu Ti Jiang
Ibrahim, Irshat
Chen, Hui
Tuerdi, Maimaitituerxun
Mayinuer,
Sonographic appearance of anal cushions of hemorrhoids
title Sonographic appearance of anal cushions of hemorrhoids
title_full Sonographic appearance of anal cushions of hemorrhoids
title_fullStr Sonographic appearance of anal cushions of hemorrhoids
title_full_unstemmed Sonographic appearance of anal cushions of hemorrhoids
title_short Sonographic appearance of anal cushions of hemorrhoids
title_sort sonographic appearance of anal cushions of hemorrhoids
topic Basic Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5449423/
https://www.ncbi.nlm.nih.gov/pubmed/28611519
http://dx.doi.org/10.3748/wjg.v23.i20.3664
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