Role of Magnetic Resonance Imaging Fistulography in Preoperative Evaluation of Perianal Fistulas
Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2017, Vol 5, Issue 6
Abstract
Introduction: As per definition, a perianal fistula is any abnormal passage connecting two epithelial surfaces of anal canal and the skin of the perineum. Objective: The objective of this study is to study the various types of perianal fistulas, delineating the primary track and complications of perianal fistula with magnetic resonance imaging (MRI) and evaluate the accuracy of MRI in the pre-operative classification. Materials and Methods: A retrospective study included 44 patients referred for MRI by 1.5T Magnetom Avanto MRI unit (Siemens Medical Systems) with clinical suspicion of perianal fistulae between January 2016 and July 2017, for evaluation of the extent of disease. Out of these 26 patients underwent surgery in our hospital and were included in the study. Imaging was performed with multiplanar T1-weighted (T1W), T2-weighted (T2W), and proton density fat saturation (PDFS) sequences. Fistulas were classified according to St. James’s University Hospital MRI based classification system (which correlates the Parks surgical classification to anatomic MRI findings) into five grades. Then, the interrelation between surgical and MRI findings was statistically analyzed. Results: A total of 26 patients were studied, MRI revealed fistulae in 21 (80.7%) patients while 5 (19.2%) patients had only perianal sinuses. Out of total 21 fistulae seen, 10 (47.6%) were intersphincteric, 9 (42.8%) were transsphincteric, and 2 (9.5%) were suprasphincteric. No extrasphincteric fistula noted. Out of these fistulae, 14 (66.6%) were simple, whereas 7 (33.3%) showed associated abscess formation, inflammation, and branching course. Statistical parameters showed that MRI has a sensitivity of 100% and specificity of 83.3% in determining type and extent of perianal fistula. Conclusion: MRI is a reliable noninvasive diagnostic modality for pre-operative assessment of perianal fistulae and guide for surgical planning by giving a correct assessment of the extent of disease, thereby reducing the chances of recurrence.
Authors and Affiliations
Sushil Kumar K Kale, Prateek Singh, Atul T Tayade, Saurabh Patil, Atul Dhok
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