Evaluating postoperative anal fistula prognosis by diffusion-weighted MRI

Liu, Xiuxiang; Wang, Zhenchang; Ren, Hua; Ren, A-Hong; Wang, Wensheng; Yang, Xuedong; Shi, Shan

doi:10.1016/j.ejrad.2020.109294

Cited by 12 publications

(18 citation statements)

References 28 publications

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“…DW-MRI can avoid the need to administer contrast (gadolinium chelate) in many cases [16]. The apparent diffusion coefficient value of the fistula on preoperative DW-MRI examination has been shown to correlate inversely with the risk of recurrence of the fistula [7]. MRI has been utilized to assess healing and response to therapy in patients with Crohn's disease with perianal fistulas [17][18][19].…”

Section: Discussionmentioning

confidence: 99%

“…It will not only relieve the patient's and surgeon's anxiety but will also make the disease less dreaded. MRI can identify and trace the fistula tracts and the internal opening with high accuracy [4][5][6][7]. It is reported that complete healing of anal fistula on MRI ('radiological healing') correlates well with long-term healing rates but there are no data in the literature that have objectively demonstrated this or quantified the accuracy of MRI in predicting longterm healing [1,7,8].…”

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confidence: 99%

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Role of MRI to confirm healing in complex high cryptoglandular anal fistulas: long‐term follow‐up of 151 cases

Garg

Yagnik²,

Kaur³

et al. 2021

Colorectal Disease

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Aim Complex fistula‐in‐ano can recur even after complete clinical healing has occurred. ‘Radiological healing’ of fistula on MRI correlates well with long‐term healing rates but no study has yet objectively quantified this. The aim of this study was to assess the accuracy of anal fistula healing as documented on MRI and to correlate it with long‐term healing as evidenced on long‐term follow‐up. Methods Patients with clinically healed anal fistulas who also had radiological healing checked by postoperative MRI were included in the study. Results Three hundred and twenty‐five patients operated for high complex fistula‐in‐ano were followed up for 14–68 months (median 38 months). Postoperative MRI was done to assess radiological healing of the fistula in 151 patients, and they were included in the study. The mean age was 39.4 ± 10.5 years (116 men). Five patients were lost to follow‐up. The fistulas did not heal radiologically (on MRI) in 20 patients and recurred in all these patients. The fistulas healed radiologically (on MRI) in 126 patients. On long‐term follow‐up, 124/126 patients remained healed while 2/126 had a recurrence. In the first patient, the fistula recurred 40 months after complete radiological healing. In the second patient, the fistula recurred 10 months after complete radiological healing but pus from the fistula tested positive for tuberculosis (by real‐time polymerase chain reaction) and he was excluded from the analysis. Thus, there was only one (1/125) recurrence on long‐term follow‐up. Conclusions Radiological healing on MRI correlates well with long‐term healing in complex fistula‐in‐ano.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Role of MRI to confirm healing in complex high cryptoglandular anal fistulas: long‐term follow‐up of 151 cases

Garg

Yagnik²,

Kaur³

et al. 2021

Colorectal Disease

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“…Newer advancements like contrast-enhanced MRI and three-dimensional modelling are being evaluated for anal fistulas[ 9 , 17 - 22 ]. These have been utilized more in Crohn’s disease rather than cryptoglandular fistulas.…”

Section: Other Advancementsmentioning

confidence: 99%

“…Contrast-enhanced MRI might provide additional input in preoperative MRI scans, but its role in the postoperative period has not been studied in great detail[ 21 ]. Diffusion-weighted MRI (DW-MRI) is superior to fat-suppressed T2-weighted images in detecting fistula tracts and also helps avoid the need to administer contrast (gadolinium chelate) in many cases[ 9 , 20 ]. However, its role in postoperative management has not yet been evaluated[ 9 , 20 ].…”

Section: Other Advancementsmentioning

confidence: 99%

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Guidelines on postoperative magnetic resonance imaging in patients operated for cryptoglandular anal fistula: Experience from 2404 scans

Garg¹,

Kaur²,

Yagnik³

et al. 2021

WJG

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Magnetic resonance imaging (MRI) is considered the gold standard for the evaluation of anal fistulas. There is sufficient literature available outlining the interpretation of fistula MRI before performing surgery. However, the interpretation of MRI becomes quite challenging in the postoperative period after the surgery of fistula has been undertaken. Incidentally, there are scarce data and no set guidelines regarding analysis of fistula MRI in the postoperative period. In this article, we discuss the challenges faced while interpreting the postoperative MRI, the timing of the postoperative MRI, the utility of MRI in the postoperative period for the management of anal fistulas, the importance of the active involvement and experience of the treating clinician in interpreting MRI scans, and the latest advancements in the field.

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Predictors of outcome in cryptoglandular anal fistula according to magnetic resonance imaging: A systematic review

Teymouri,

Keshvari,

Ashjaei

et al. 2023

Health Science Reports

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Background and Aims: Anal fistula (AF) with cryptoglandular origin tends to recur, and multiple risk factors are implicated. Recently, some magnetic resonance imaging (MRI) findings with predictive value for disease outcomes have been proposed. These intrinsic anatomic features include those of the AF and its surrounding structures. This study aims to clarify the prognostic role of MRI in AF.Methods: We performed a systematic search of PubMed, Embase, and EBSCO databases. Two independent reviewers conducted the search and screened the articles. We selected studies that used MRI to assess AF and reported its relationship to disease outcome. We extracted data regarding the study design, type of intervention, outcome, MRI-measured items, and their significance.Results: Out of 1230 retrieved articles, 18 were eligible for final inclusion, and a total of 4026 patients were enrolled in the selected studies. For preoperative MRI, the significant items affecting the outcome were the length of the fistula, horseshoe type, presence of multiple tracts, supralevator extension, and apparent diffusion coefficient (ADC) value. Other studies investigated the healing process using postoperative MRI. Conclusion:This review found that MRI can be useful in the management of AF, both preoperatively and postoperatively. Factors, such as fistula length, horseshoe type, presence of multiple tracts, supralevator extension, and ADC value were found to be significantly associated with treatment outcomes. The presence of the fistula tract and the development of new abscesses on postoperative MRI was found to hinder the healing process. Further studies are needed to confirm these findings.

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Evaluating postoperative anal fistula prognosis by diffusion-weighted MRI

Cited by 12 publications

References 28 publications

Role of MRI to confirm healing in complex high cryptoglandular anal fistulas: long‐term follow‐up of 151 cases

Role of MRI to confirm healing in complex high cryptoglandular anal fistulas: long‐term follow‐up of 151 cases

Guidelines on postoperative magnetic resonance imaging in patients operated for cryptoglandular anal fistula: Experience from 2404 scans

Predictors of outcome in cryptoglandular anal fistula according to magnetic resonance imaging: A systematic review

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