{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T19:13:33Z","timestamp":1791918813054,"version":"4.3.4"},"reference-count":19,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,1,24]],"date-time":"2019-01-24T00:00:00Z","timestamp":1548288000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The current \u201cgold standard\u201d to diagnose anal sphincter morphology and disruptions utilizes low\u2010frequency (3\u20109\u00a0MHz) ultrasound (US) imaging techniques that provide a general outline of the sphincter muscles, but not their microstructural details. High\u2010frequency US transducers (7\u201015\u00a0MHz) have been used to study the muscle architecture (direction of muscle fascicles) in the limb muscle.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>The goal of our study was to visualize the microstructural anatomy of the anal sphincters, specifically the external anal sphincter (EAS), using high\u2010frequency US imaging.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Studies were conducted in asymptomatic female and male subjects and patients with fecal incontinence. US images were acquired using a low\u2010frequency US (3\u20109\u00a0MHz) and high\u2010frequency (7\u201015\u00a0MHz) US transducer. The latter was placed intra\u2010anally to image the anal canal at 12, 9, 3, and 6 o'clock positions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The low\u2010frequency US images revealed the general outline of the anal sphincter muscles. On the other hand, high\u2010frequency imaging visualized muscle fascicles and connective tissue inside the external anal sphincter (EAS). In FI patients, there was loss of muscle fascicles and alteration in the echo\u2010intensity pattern in the region of damaged EAS suggestive of muscle fibrosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>High\u2010frequency ultrasound imaging is a powerful tool to visualize the microstructural details of the EAS. Our studies show that damage to the EAS muscle results in the alteration of its myoarchitecture, that is, loss of muscle fascicles and increase in the muscle connective tissue.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.13537","type":"journal-article","created":{"date-parts":[[2019,1,25]],"date-time":"2019-01-25T05:29:54Z","timestamp":1548394194000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["High\u2010frequency ultrasound imaging of the anal sphincter muscles in normal subjects and patients with fecal incontinence"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3705-3889","authenticated-orcid":false,"given":"Melissa","family":"Ledgerwood\u2010Lee","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine and Department of Biomedical Engineering University of California San Diego ACTRI  La Jolla California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Zifan","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine and Department of Biomedical Engineering University of California San Diego ACTRI  La Jolla California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7319-8677","authenticated-orcid":false,"given":"David C.","family":"Kunkel","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine and Department of Biomedical Engineering University of California San Diego ACTRI  La Jolla California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Sah","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine and Department of Biomedical Engineering University of California San Diego ACTRI  La Jolla California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0181-9697","authenticated-orcid":false,"given":"Ravinder K.","family":"Mittal","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine and Department of Biomedical Engineering University of California San Diego ACTRI  La Jolla California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,1,24]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199312233292601"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02049319"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0b013e3182a18e87"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2004.047696"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2008.08.019"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0b013e3182a18e87"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.3923"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.12481"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1098\/rstb.2010.0316"},{"issue":"85","key":"e_1_2_8_11_1","first-page":"398","article-title":"Architectural and functional features of human triceps surae muscles during contraction","volume":"1998","author":"Kawakami Y","year":"1985","journal-title":"J Appl Physiol"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-971957"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.1826"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.1827"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gtc.2008.06.003"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpgi.00338.2013"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpcell.00173.2013"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpcell.00328.2012"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpgi.00450.2013"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ultrasmedbio.2008.09.016"}],"container-title":["Neurogastroenterology &amp; 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