Dynamic contrast-enhanced MR imaging of perianal fistulas.

Spencer, J A; Ward, J.P.; Beckingham, I. J.; Adams, Carl S.; Ambrose, N. S.

doi:10.2214/ajr.167.3.8751692

Cited by 142 publications

(100 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These findings are consistent with the results of Spencer et al (6), who suggested that axial and coronal contrast-enhanced T1W and axial T2W sequences should provide adequate information to guide surgery. In our study, however, we evaluated a more detailed classification of fistulas and internal openings, the positions of which were indicated by reference to a clock face (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). Also, additional findings, such as the presence of a horseshoe extension or inflammation, were evaluated separately.…”

Section: Images (C)supporting

confidence: 92%

“…The location of the internal opening with respect to a clock face (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12), the presence or absence of sinus tracks, abscesses, a horseshoe component and coexisting inflammation and the distance of the internal opening to the anal orifice (in mm) were noted for each of the MRI sequences listed above. It was also noted if no decision could be made.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Ideal combination of sequences for perianal fistula classification and evaluation of additional findings for readers with varying experience

Yıldırım

Gökalp²,

Öztürk³

et al. 2011

Diagn Interv Radiol

View full text Add to dashboard Cite

Perianal fistula is a common disease that most commonly originates from anal gland infections. Medical therapy has little treatment value, and patients eventually undergo surgery. The success of the surgery is closely associated with the preoperative evaluation (1). Therefore, it is of utmost importance to evaluate the course of the fistula and the presence of associated findings before surgical intervention because it can influence the surgical approach (2). Also, because recurrence is one of the most important problems following surgery, identification of the extensions of the disease with imaging methods aids in the surgical elimination of all sources of infection and ultimately decreases the percentage of recurrent disease (3).The preoperative evaluation of a fistula track by a surgeon includes inspection, palpation, probing, and the injection of colored dyes (2). The imaging methods employed to evaluate perianal fistulas are fistulography, computed tomography (CT), three dimensional (3D) endoanal ultrasonography (EAUS) (with or without the instillation of hydrogen peroxide into the track), and magnetic resonance imaging (MRI) with endoanal or pelvic coils or both. The description and classification of the primary track, the location of the internal opening (the radial site and the level), the presence of extensions (especially horseshoe extensions) and the presence of an abscess formation are the critical parameters for a complete evaluation of a fistula and should be implicated in the radiological reports. MRI is reported to be the most sensitive imaging method because it allows for the evaluation of secondary tracks and the detection of any possible extension to the supralevator fossa. Previous investigations performed to determine the role of MRI in this problem have indicated the value of the technique (2, 4-11). A concordance rate of 86%-88% between MRI and surgical findings was reported for the detection and classification of fistulas (12,13).To the best of our knowledge, no previous reports have evaluated the value of each sequence for assessing the specific surgical parameters in addition to fistula classification. The purpose of our study was to assess the contribution of different MRI sequences in determining the perianal fistula type and in obtaining critical information for surgical decisions, as well as to define the optimal combination of sequences for readers with varying levels of experience. Materials and methods Patient selectionThirty-three MRI examinations in 26 patients, obtained between 2007 and 2010, were included in the study. Fifteen of the patients were male, and 11 were female. The ages of the patients ranged from 30 to 84 years (mean age, 48 years). Three patients were known to have underlying inflammatory bowel disease. There was no evidence of diabetes melli- ABDOMINAL IMAGING ORIGINAL ARTICLE Ideal combination of MRI sequences for perianal fistula classification and the evaluation of additional findings for readers with varying levels of experienceNalan Yıldırım, Gökhan Gökalp...

show abstract

Section: Images (C)supporting

confidence: 92%

Section: Resultsmentioning

confidence: 99%

Ideal combination of sequences for perianal fistula classification and evaluation of additional findings for readers with varying experience

Yıldırım

Gökalp²,

Öztürk³

et al. 2011

Diagn Interv Radiol

View full text Add to dashboard Cite

show abstract

“…Torkzad MR et al . Optimal MRI of fistula-in-ano mation [20][21][22] . To our knowledge, there has never been a published work which has said that T1 sequence should be used.…”

Section: T1 Vs T2 Weighted Imagesmentioning

confidence: 99%

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

Torkzad¹,

Åhlström²,

Karlbom³

2014

WJR

View full text Add to dashboard Cite

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

show abstract

“…MRI has reported good sensitivity and specificity in demonstrating primary and secondary tracts as well as abscesses in perianal fistulae (8). Furthermore, contrastenhanced MRI has been reported to accurately differentiate active from inactive perianal disease (10) and assess response to treatment in active disease (11,12).…”

Section: Discussionmentioning

confidence: 99%

“…Actively inflamed fistulous tracts and abscesses have been reported to have characteristic enhancement features on dynamic contrastenhanced MRI (8). Low anorectal cancers that develop in perianal fistulae can be subtle and difficult to diagnose, both clinically and radiologically.…”

mentioning

confidence: 99%

MRI appearance of perianal carcinoma in Crohn's disease

Lad

Haider

Brown

et al. 2007

Magnetic Resonance Imaging

View full text Add to dashboard Cite

Detection of carcinoma in perianal Crohn's disease can be difficult. The purpose of this study was to describe the MRI appearance of anorectal cancer in patients with perianal Crohn's disease. A total of six patients with anorectal carcinoma (four mucinous adenocarcinoma, two squamous) in Crohn's disease were retrospectively reviewed. Axial T2 and dynamic postcontrast fat‐suppressed T1‐weighted gradient echo sequences were performed, and findings were compared with 18 noncancer patients with perianal fistulae in Crohn's disease. MRI characteristics of carcinoma were irregular inner wall contours and delayed mild enhancement of internal tissue. The combined features of an irregular internal wall and delayed enhancing tissue were seen exclusively in cancer patients. The four cases of mucinous adenocarcinoma all displayed a pattern of lobulated fluid‐filled cavities with delayed internal tissue enhancement. This pattern was not seen in any of the control cases. The presence of a double‐layered enhancement pattern was seen in both cases of squamous carcinoma and in only one of four cases of mucinous adenocarcinoma and one of 18 noncancer cases. The pattern of contrast enhancement is valuable in the MRI diagnosis of carcinoma in perianal Crohn's disease. J. Magn. Reson. Imaging 2007. © 2007 Wiley‐Liss, Inc.

show abstract

Dynamic contrast-enhanced MR imaging of perianal fistulas.

Cited by 142 publications

References 9 publications

Ideal combination of sequences for perianal fistula classification and evaluation of additional findings for readers with varying experience

Ideal combination of sequences for perianal fistula classification and evaluation of additional findings for readers with varying experience

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

MRI appearance of perianal carcinoma in Crohn's disease

Contact Info

Product

Resources

About