A comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluation of Crohn's perianal fistulas

Schwartz, David A.; Wiersema, Maurits J.; Dudiak, Kika M.; Fletcher, Joel G.; Clain, Jonathan E.; Tremaine, William J.; Zinsmeister, Alan R.; Norton, Ian D.; Boardman, Lisa A.; Devine, Richard M.; Wolff, Bruce G.; Young‐Fadok, Tonia M.; Diehl, Nancy N.; Pembérton, John H.; Sandborn, William J.

doi:10.1053/gast.2001.28676

Cited by 514 publications

(278 citation statements)

References 21 publications

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“…EAUS was inferior to MRI in most earlier studies [11,22] , and it was inferior [2,23] or equivalent [24,25] in subsequent studies. A conventional 2D-EAUS was used in most of these comparative studies.…”

Section: Kim Y Et Al Endoanal Ultrasound In Anal Fistulamentioning

confidence: 87%

Three-dimensional endoanal ultrasonographic assessment of an anal fistula with and without H₂O₂enhancement

Kim¹,

Park²

2009

WJG

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AIM:To evaluate the effectiveness of three-dimensional endoanal ultrasound (3D-EAUS) in the assessment of anal fistulae with and without H2O2 enhancement. METHODS:Sixty-one patients (37 males, aged 17-74 years) with anal fistulae, which were not simple low types, were evaluated by physical examination and 3D-EAUS with and without enhancement. Fistula classification was determined with each modality and compared to operative findings as the reference standard. RESULTS:The accuracy of 3D-EAUS was significantly higher than that of physical examination in detecting the primary tract (84.4% vs 68.7%, P = 0.037) and secondary extension (81.8% vs 62.1%, P = 0.01) and localizing the internal opening (84.2% vs 59.7%, P = 0.004). A contrast study with H2O2 detected several more fistula components including two primary suprasphincteric fistula tracks and one supralevator secondary extension, which were not detected on non-contrast study. However, there was no significant difference in accuracy between 3D-EAUS and H2O2-enhanced 3D-EAUS with respect to classification of the primary tract (84.4% vs 89.1%, P = 0.435) or secondary extension (81.8% vs 86.4%, P = 0.435) or localization of the internal opening (84.2% vs 89.5%, P = 0.406).CONCLUSION: 3D-EAUS was highly reliable in the diagnosis of an anal fistula. H2O2 enhancement was helpful at times and selective use in difficult cases may be economical and reliable.

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Section: Kim Y Et Al Endoanal Ultrasound In Anal Fistulamentioning

confidence: 87%

Three-dimensional endoanal ultrasonographic assessment of an anal fistula with and without H₂O₂enhancement

Kim¹,

Park²

2009

WJG

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“…Treatment of fistula-in-ano requires adequate knowledge of its extensions [1][2][3][4][5] . Magnetic resonance imaging (MRI) is the single best imaging modality for this purpose, although sometimes the addition of other tests such as endoanal ultrasound (EUS) is required.…”

Section: Introductionmentioning

confidence: 99%

Comparison of different magnetic resonance imaging sequences for assessment of fistula-in-ano

Torkzad¹,

Åhlström²,

Karlbom³

2014

WJR

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AIM:To assess agreement between different forms of T2 weighted imaging (T2WI), and post-contrast T1WI in the depiction of fistula tracts, inflammation, and internal openings with that of a reference test. METHODS:Thirty-nine consecutive prospective cases were enrolled. The following sequences were used for T2WI: 2D turbo-spin-echo (2D T2 TSE); 3D T2 TSE; short tau inversion recovery (STIR); 2D T2 TSE with fat saturation performed in all patients. T1WI were either a 3D T1-weighted prepared gradient echo sequence with fat saturation or a 2D T1 fat saturation [Spectral presaturation with inversion (SPIR)]. Agreement for each sequence for determination of fistula extension, internal openings, and the presence of active inflammation was assessed separately and blindly against a reference test comprised of follow-up, surgery, endoscopic ultrasound, and assessment by an independent experienced radiologist with access to all images. RESULTS:Fifty-six fistula tracts were found: 2 intersphincteric, 13 trans-sphincteric, and 24 with additional tracts. The best T2 weighted sequence for depiction of fistula tracts was 2D T2 TSE (Cohen's kappa = 1.0), followed by 3D T2 TSE (0.88), T2 with fat saturation (0.54), and STIR (0.19). Internal openings were best seen on 2D T2 TSE (Cohen's kappa = 0.88), followed by 3D T2 TSE (0.70), T2 with fat saturation (0.54), and STIR (0.31). Detection of inflammation showed Cohen's kappa of 0.88 with 2D T2 TSE, 0.62 with 3D T2 TSE, 0.63 with STIR, and 0.54 with T2 with fat saturation. STIR, 3D T2 TSE, and T2 with fat saturation did not make any contributions compared to 2D T2 TSE. Post-contrast 3D T1 weighted prepared gradient echo sequence with fat saturation showed better agreement in the depiction of fistulae (Cohen's kappa = 0.94), finding internal openings (Cohen's kappa = 0.97), and evaluating inflammation (Cohen's kappa = 0.94) compared to post-contrast 2D T1 fat saturation or SPIR where the corresponding figures were 0.71, 0.66, and 0.87, respectively. Comparing the best T1 and T2 sequences showed that, for best results, both sequences were necessary. CONCLUSION: 3D T1 weighted sequences were best for the depiction of internal openings and active inflammatory components, while 2D T2 TSE provided the best assessment of fistula extension. Key words: Fistula; Magnetic resonance imaging; Diagnosis Core tip: Both T1 (post-contrast) and T2 weighted sequences are needed for the best assessment of fistulain-ano; T2 weighted imaging: 2D turbo-spin-echo (2D T2 TSE) is most useful for depiction in relation to sphincter muscles. 3D T2 TSE cannot replace 2D T2 TSE. Post-contrast 3D T1 weighted prepared gradient echo sequence with fat saturation is necessary for the CASE CONTROL STUDY

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“…Several studies have found EAUS to be inferior to pelvic MRI in the diagnosis of perianal disease [47][48][49]. With the use of threedimensional reconstruction of two-dimensional images, however, some investigators have shown that the results of EAUS are comparable with MRI, with excellent patient tolerance [34,50].…”

Section: Comparison With Other Imaging Modalitiesmentioning

confidence: 99%

MRI of Crohn?s Anoperineal Disease

McDermott¹

2013

J Gastrointest Dig Syst

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Anoperineal involvement is seen in up to 38% of patients with Crohn's disease. To adopt the best treatment strategy and avoid recurrences, it is important to obtain precise radiological information of the fistulous track. Magnetic resonance imaging provides precise information on the anatomy of the anal canal, the anal sphincteric complex, and the relationship of the fistula to the pelvic floor structures. In this article we review the anatomy of the anal canal, the pathogenesis of perianal fistula, different MRI sequences for the evaluation of fistula with emphasis on their imaging findings and an MR imaging based grading system for their classification.

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A comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluation of Crohn's perianal fistulas

Cited by 514 publications

References 21 publications

Three-dimensional endoanal ultrasonographic assessment of an anal fistula with and without H₂O₂enhancement

Three-dimensional endoanal ultrasonographic assessment of an anal fistula with and without H₂O₂enhancement

Comparison of different magnetic resonance imaging sequences for assessment of fistula-in-ano

MRI of Crohn?s Anoperineal Disease

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A comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluation of Crohn's perianal fistulas

Cited by 514 publications

References 21 publications

Three-dimensional endoanal ultrasonographic assessment of an anal fistula with and without H2O2enhancement

Three-dimensional endoanal ultrasonographic assessment of an anal fistula with and without H2O2enhancement

Comparison of different magnetic resonance imaging sequences for assessment of fistula-in-ano

MRI of Crohn?s Anoperineal Disease

Contact Info

Product

Resources

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Three-dimensional endoanal ultrasonographic assessment of an anal fistula with and without H₂O₂enhancement

Three-dimensional endoanal ultrasonographic assessment of an anal fistula with and without H₂O₂enhancement