PATTERNS OF PERIANAL FISTULA IN MAGNETIC RESONANCE IMAGING AND ITS USEFULNESS IN THEIR PRE-SURGICAL EVALUATION
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 21
Abstract
BACKGROUND Until recently, cross-sectional imaging had a limited role in the preoperative assessment of perianal fistulas. Magnetic resonance imaging (MRI) has been shown to be an effective and essential imaging method in the evaluation of fistula-in-ano and the multiplanar images acquisition has demonstrated to be extremely useful in the surgical planning. Considering its high reliability in the reproduction of perianal anatomy, allowing the characterization and classification of the fistula based on its relation with the pelvic diaphragm and the anal sphincter is contributing for a successful surgical approach and thus avoiding the disease recurrence. 1 Aims and Objectives- The aim of this study is to describe the various patterns and grading of perianal fistulae in Magnetic Resonance Imaging (MRI) and to assess its diagnostic accuracy and usefulness in preoperative evaluation. 1. The type, number and extent of perianal fistula. 2. Fistulous tracts in relation to the sphincter complex, ischiorectal/ ischioanal fossa and levator ani plate and their MRI grading. 3. Patterns, locations and sides of external and internal openings. 4. Involvement of pelvic floor/ viscera. 5. Perianal abscess, horseshoe fistulas, ramifications, subcutaneous oedema and sinuses. 6. The diagnostic accuracy and usefulness of MRI in preoperative evaluation as compared with postoperative diagnosis. MATERIALS AND METHODS This prospective observational study was performed in the Department of Radiodiagnosis and Imaging, Dr. Somervell Memorial CSI Medical College, Karakonam in the period between January - July 2017. A total of 100 patients who presented to Surgical OPD of Dr. Somervell Memorial CSI Medical College, suspected of perianal disease were included for the purpose of the study. Inclusion Criteria Patients presenting to Surgical OPD of SM-CSI with signs and symptoms like1. Perianal discharge. 2. Pain. 3. Swelling. 4. Bleeding. 5. Diarrhoea. 6. Skin excoriation. 7. External opening. 8. Patients with known Crohn’s disease. 9. Patients with history of previous intervention and recurrence. Exclusion Criteria 1. Patients not willing to participate in the study. 2. Claustrophobic patients. 3. Patients having any metallic/ electronic implants in the body. RESULTS A total of 50 patients, who presented to Surgical OPD of SM-CSI, suspected of perianal disease were included for the purpose of the study. Maximum number of cases were observed in the age group of 31 - 40 years and minimum number of cases were observed in <20 years’ age group. The youngest patient was of 18 years of age and the oldest was of 58 years. All cases are more common in males than females. About two-thirds of all the cases are having complaint of pain and swelling. Among all cases 86 cases were diagnosed by MRI as perianal fistula, 6 cases as sinus and 8 cases as abscess. Maximum number of cases of perianal fistula were observed in the age group of 31 - 40 years and no case of perianal fistula was observed in < 20 years’ age group. The youngest patient was of 25 years age and the oldest was of 58 years. Sinus and abscess cases were almost evenly distributed in all age groups. Among perianal fistula cases, 86% were male patients. All sinus cases were male patients and among abscess cases 75% were male patients. Among perianal fistulae cases, 76% cases are of low type. Among perianal fistulae cases, 23% cases are having ischiorectal/ ischioanal fossae involvement. Among perianal fistulae, 49% cases are of grade I > followed by Grade II (28%) > Grade IV (11%) > Grade III (7%) > Grade V (5%). 95% of fistulae cases and all cases of abscess were managed operatively, while conservative management was done in all sinus cases. Overall, 90% cases underwent operative management, while conservative management was done in 10% cases. CONCLUSION MRI is having excellent results in showing rectum, perianal region, internal and external anal sphincter, levator ani, ischiorectal and ischioanal region. It can show the relationship between fistula and the sphincteric mechanism and can describe the primary fistulous passage as well as the secondary ramification and associated abscess. Diagnostic accuracy of preoperative MRI as compared to postoperative diagnosis was found to be 97.77%. Overall, sensitivity of preoperative MRI diagnosis is 97.7% with 95% Confidence Interval between 86.7% - 99.8%. The positive predictive value was found to be 100%. So, we can conclude that with accuracy of 97.77% in this study high-spatial-resolution MR imaging is a highly accurate, rapid and non-invasive imaging technique for preoperative evaluation of perianal disease.
Authors and Affiliations
Sebastian Varghese, Krishna Chaitanya Nunna
Keywords
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- EP ID EP431663
- DOI 10.14260/jemds/2018/589
- Views 69
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