“Clinical relevance of sacral ratio and sacral curvature in the radiological classification of anorectal malformations”

Background Anorectal malformations (ARMs) are congenital anomalies that affect the developing hindgut. Sacral development can be used as a prognostic factor in these patients because it parallels the development of the muscles and nerves of the perineum. This study aimed to evaluate the validity of using sacral ratio (SR) and sacral curvature (SC) as predictors for the type of ARMs. Methods A prospective radiological observational study was conducted on 23 newborns with ARMs at Aswan University Hospitals. ARMs were classified according to the Wingspread classification into low, intermediate, and high. Sacral SR was measured in anteroposterior (AP) and lateral views and SC was measured in lateral view. Both were correlated with ARMs type. Results High-type ARMs represented 47.8%, low and intermediate were 39.1% and 13%, respectively. Perineal fistula was the most common anomaly (30.4%). SR in both AP and lateral views was significantly lower in the high ARMs group compared to other groups ( p < 0.001). SC showed a lower mean in high ARMs but without statistically significant difference ( p = 0.115). Conclusions SR in both AP and lateral views is a reliable marker for predicting ARMs severity. SC may provide complementary insights. Routine SR assessment is recommended in newborns with ARMs.