Background Perianal sepsis and fistulas are common lesions. Fistula-in-ano is a tedious problem because of high recurrence rates and severe unexpected complications postoperatively. Many imaging modalities are used to evaluate this area. Magnetic resonance imaging (MRI) has been considered the gold standard procedure for perianal fistula assessment, i.e., it provides the surgeon with an accurate roadmap to select the best surgical approach, determines the extent of sphincter division, and estimates the risk of postoperative incontinence. We carried out a prospective diagnostic accuracy study involving 50 patients (mean age, 42.44 years) with perianal fistulas who underwent pelvic MRI with a 1.5 Tesla scanner using multiple sequences, including diffusion and post-contrast series that were either local or systemic. This study aimed to evaluate the diagnostic validity of pelvic MRI/MR fistulogram in perianal fistula assessment, identify perianal fistula-associated findings by MRI, and optimize the MRI technique with maximum technical safety. Results Intersphincteric fistulas were the most common type of perianal fistula observed based on Parks’ classification. Intersphincteric, trans-sphincteric, extrasphincteric, and suprasphincteric fistulas were found in 30 (60%), 12 (24%), 4 (8%), and 4 (8%) patients, respectively. According to St. James’ classification, 21 (42%), 9 (18%), 8 (16%), 4 (8%), and 8 (16%) patients had perianal fistula grades I, II, III, IV, and V, respectively. The combination of variable MR sequences and MR fistulogram increased the diagnostic validity of MRI examinations. Our results correlated with surgical results (reference standard) with perfect interobserver reliability. Conclusions Of all imaging modalities, MRI has become a prerequisite for a successful surgery of a perianal fistula. MRI can identify: (a) fistula morphological details, (b) the relationship between the fistulous tract and the anal sphincter, (c) fistula wound healing, (d) an active versus chronic scarred fistula, (e) postoperative stigmata, and (f) a perianal fistula from its mimics. MRI with variable sequences and MRI fistulogram are successful combinations that increase diagnostic efficiency with technical safety by avoiding both ionizing radiation and systemic gadolinium.
Background: Anal fistula is one of the most frequently reported anorectal disorders that has a propensity to recur, particularly in complex cases usually because of un-detected sepsis at operation time. The aim of our review was to assess the diagnostic validity of pelvic MRI with MR Fistulogram in the diagnosis, assessment and classification of Peri-anal fistula. Main text: A broad literature review has been done, searching the electronic databases including Google Scholar and PubMed using keywords like perianal fistula, MRI, and anorectal sepsis, in addition to the standard text-books of colorectal diseases. Contrast X-rays, CT scans, anal endo-sonography, and MRI are the methods utilized for pre-operative scanning of fistula in ano. Because of its low accuracy, X-ray fistulography seldomly utilized for imaging of peri-anal fistula. CT fistula-graphy may be more precise in patients presented with acute inflammation, abscess or the fistulae connected with inflammatory bowel diseases. Anal endo-sonography and MR-imaging are commonly utilized and dependable imaging methods for fistula in ano. The usage of 3D technologies has upgraded the precision of anal endo-sonography. MR-Imaging is now considered the favorite option. But, several researches have showed similar accuracies for both MR-Imaging and anal endo-sonography with similar sensitivity. However, with more MRI specificity.Conclusion: MRI is extremely effective in preoperative classification of Peri-anal fistulae, thus enabling selection of correct surgical procedure and preventing recurrence.
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