Krois W, Palmisani F, Gröpel P, et al. - In patients with anorectal malformations (ARM), an established predictive marker for functional prognosis is the sacral ratio (SR) which is derived from conventional radiographs. Recent works have reported magnetic resonance imaging (MRI) as a diagnostic alternative for preoperative/baseline assessment of patients with ARM. Researchers here examined if reliable measurement of the SR could be done from MRI images and if it correlated with SR measurements obtained from radiographs. MRI data and conventional radiographs from 31 individuals were analyzed by two raters (n = 17 with ARM; n = 14 controls). Per findings, derivation of the SR can be done from MRI images with good inter-rater reliability. Marginally higher SR value was obtained when calculation was done on MRI, presumably due to inclusion of cartilaginous yet unossified structures.