{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T06:47:37Z","timestamp":1780469257289,"version":"3.54.1"},"reference-count":27,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2022,11,10]],"date-time":"2022-11-10T00:00:00Z","timestamp":1668038400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2022,11,10]],"date-time":"2022-11-10T00:00:00Z","timestamp":1668038400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the agreement between three\u2010dimensional endoanal ultrasound (EAUS) and four\u2010dimensional transperineal ultrasound (TPUS) in measuring anal sphincter defect angle.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a secondary analysis of the PERINEAL study, which evaluated the effect of perineal wound infection on anal sphincter integrity. Women were reviewed once a week, until their perineal wound had healed or for up to a maximum of 16\u2009weeks. At each visit, both EAUS and TPUS (the latter at rest and on maximum pelvic floor muscle contraction (PFMC)) were performed to evaluate the presence of external (EAS) and internal\u00a0(IAS) anal sphincter defect and measure the defect size. The largest angle size of a defect at the same sphincter level was analyzed. A defect was deemed significant if it was &gt;\u200930\u00b0. Kappa coefficient (\u03ba), intraclass correlation coefficient and standard error of measurement (SEM) were calculated, using EAUS as the reference standard.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In 73 women scanned at weekly intervals, a total of 250 EAUS and 250 TPUS scans were performed. An EAS defect was found in 55 (22.0%) EAUS images and 47 (18.8%) TPUS images. An IAS defect was found in 26 (10.4%) images on both modalities. There was excellent agreement (\u03ba\u2009=\u20090.87) between TPUS and EAUS in diagnosing the presence of an EAS defect and perfect agreement (\u03ba\u2009=\u20091.00) in diagnosing the presence of an IAS defect. TPUS performed at rest had poor and moderate agreement with EAUS in measuring EAS and IAS defect size, respectively, with respective SEMs of \u00b1\u200916.1\u00b0 and\u00a0\u00b1\u200927.9\u00b0. TPUS performed during maximum PFMC had poor and moderate agreement with EAUS in measuring EAS and IAS defect size, respectively, with respective SEMs of \u00b1\u200916.5\u00b0 and\u00a0\u00b1\u200926.4\u00b0. Based on the SEMs, if the diagnostic cut\u2010off of 30\u00b0 for defect size on TPUS was used, an incorrect diagnosis of significant EAS defect could occur in approximately 9\u201336% of women and an incorrect diagnosis of a significant IAS defect could occur in approximately 4\u201315% of women, using EAUS as the reference.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This is the first study to compare directly anal sphincter defect angle measurements obtained on EAUS and TPUS. A cut\u2010off angle of 30\u00b0 should not be used for the diagnosis of a significant residual anal sphincter defect during TPUS examination. Further research is required to determine the optimal defect cut\u2010off angle for TPUS. \u00a9 2022 The Authors. Ultrasound in Obstetrics &amp; Gynecology published by John Wiley &amp; Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.24957","type":"journal-article","created":{"date-parts":[[2022,5,31]],"date-time":"2022-05-31T03:38:53Z","timestamp":1653968333000},"page":"793-799","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Comparison of diagnostic criteria for significant anal sphincter defects between endoanal and transperineal ultrasound"],"prefix":"10.1002","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0786-2354","authenticated-orcid":false,"given":"N. A.","family":"Okeahialam","sequence":"first","affiliation":[{"name":"Urogynaecology and Pelvic Floor Reconstruction Unit Croydon University Hospital  Croydon UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Thakar","sequence":"additional","affiliation":[{"name":"Urogynaecology and Pelvic Floor Reconstruction Unit Croydon University Hospital  Croydon UK"},{"name":"St George's University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8979-2304","authenticated-orcid":false,"given":"A. H.","family":"Sultan","sequence":"additional","affiliation":[{"name":"Urogynaecology and Pelvic Floor Reconstruction Unit Croydon University Hospital  Croydon UK"},{"name":"St George's University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,11,10]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/jum.14953"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800810349"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02049319"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-016-3140-3"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.14845"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/jum.14246"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-84628-503-5_10"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-009-0908-8"},{"key":"e_1_2_8_10_1","first-page":"102","volume-title":"Perineal and Anal Sphincter Trauma: Diagnosis and Clinical Management","author":"Scott SM","year":"2009"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-020-04607-8"},{"key":"e_1_2_8_12_1","unstructured":"SultanAH.The Effect of Perineal Wound Infection on the Anal Sphincter.ClinicalTrials.govIdentifier: NCT04480684.https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04480684?term=04480684&draw=2&rank=1."},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.920"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61602-X"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcm.2016.02.012"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.11613\/BM.2012.031"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-014-2406-x"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000833"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-018-3601-y"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2020.04.063"},{"key":"e_1_2_8_21_1","unstructured":"RCOG.The Management of Third and Fourth\u2010degree Perineal Tears. Green\u2010Top Guideline No. 29.https:\/\/www.rcog.org.uk\/media\/5jeb5hzu\/gtg\u201029.pdf."},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31930-5"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2019.04.009"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1098\/rstb.2017.0318"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-020-04669-8"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-019-04130-5"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.5155"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13701"}],"container-title":["Ultrasound in Obstetrics &amp; Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.24957","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/uog.24957","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.24957","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T08:42:22Z","timestamp":1779093742000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.24957"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,10]]},"references-count":27,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["10.1002\/uog.24957"],"URL":"https:\/\/doi.org\/10.1002\/uog.24957","archive":["Portico"],"relation":{},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,10]]},"assertion":[{"value":"2022-01-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-05-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-11-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}