Diffusion-weighted MRI for evaluating perianal fistula activity: Feasibility study

Yoshizako, Takeshi; Wada, Akihiko; Takahara, Taro; Kwee, Thomas C.; Nakamura, Megumi; Uchida, Kôji; Hara, Shinji; Luijten, Peter R.; Kitagaki, Hajime

doi:10.1016/j.ejrad.2011.06.052

Cited by 43 publications

(56 citation statements)

References 18 publications

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“…The numbers of sequences that could be employed are many, with several that were not assessed by us. A recent Japanese study [25] employed diffusion weighted imaging in 24 patients for the assessment of disease activity and found it to be a feasible method. They employed b-values of 0 and 1000.…”

Section: A B a Bmentioning

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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Section: A B a Bmentioning

confidence: 99%

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

Torkzad¹,

Åhlström²,

Karlbom³

2014

WJR

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Section: Application Of Dwi In the Assessment Of Perianal Fistulasmentioning

confidence: 99%

“…The authors have indeed comprehensively touched on the nononcologic applications of DWI in the evaluation of the gastrointestinal system, including pancreatic, hepatobiliary, splenic, and bowel pathologies. However, we would like to add to the list of nononcologic applications by highlighting the potential role of DWI in the evaluation of perianal fistulas [2][3][4][5][6][7].DWI provides excellent visualization of the perianal fistulas as high-signal-intensity tracts against the significantly suppressed background signal [2][3][4]. Thanks to the high lesion-to-background contrast, DWI can add to confidence in the diagnosis [2,4].…”

mentioning

confidence: 99%

Application of DWI in the Assessment of Perianal Fistulas

Arora

Bansal

Sureka

2015

American Journal of Roentgenology

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Application of DWI in the Assessment of Perianal FistulasWe zealously read the article "Nononcologic Applications of Diffusion-Weighted Imaging in the Gastrointestinal System" by Dunn et al. [1], which appeared in the April 2015 issue of the American Journal of Roentgenology. We would like to thank the authors for their elucidatory review on a relatively unplumbed topic. Although it is true that DWI has a predominant role in oncologic scenarios, its nononcologic applications, especially in the evaluation of gastrointestinal and abdominal diseases, are increasing. The authors have indeed comprehensively touched on the nononcologic applications of DWI in the evaluation of the gastrointestinal system, including pancreatic, hepatobiliary, splenic, and bowel pathologies. However, we would like to add to the list of nononcologic applications by highlighting the potential role of DWI in the evaluation of perianal fistulas [2][3][4][5][6][7].DWI provides excellent visualization of the perianal fistulas as high-signal-intensity tracts against the significantly suppressed background signal [2][3][4]. Thanks to the high lesion-to-background contrast, DWI can add to confidence in the diagnosis [2,4]. In 2009, Hori and colleagues [2] studied the role of DWI in diagnosing perianal fistulas. Of the 20 anal fistulas diagnosed, 18 (90%) were detected on T2-weighted images and 19 (95%) were detected on DW images and T2weighted images combined. Although there was no statistically significant difference in the sensitivity of the techniques (for all comparison pairs, p > 0.5), the confidence scores associated with DW images and T2-weighted images combined were significantly greater Downloaded from www.ajronline.org by University of Florida on 10/05/15 from IP address 159.178.22.27.

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“…The Crohn's disease anoperineal lesions ISSN: 2161-069X JGDS, an open access journal coefficient [ADC] was significantly lower in the positive inflammation activity group compared to the negative inflammation activity group [40].…”

Section: J Gastroint Dig Systmentioning

confidence: 99%

“…Recently the use of DWI has been examined in evaluating perianal fistula [39,40]. On these images the fistulous tracks appear hyperintense, whereas the background signal is significantly suppressed.…”

Section: Diffusion-weighted Imaging (Dwi)mentioning

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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Diffusion-weighted MRI for evaluating perianal fistula activity: Feasibility study

Cited by 43 publications

References 18 publications

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

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

Application of DWI in the Assessment of Perianal Fistulas

MRI of Crohn?s Anoperineal Disease

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