Prospective evaluation of dynamic contrast enhanced magnetic resonance imaging in the evaluation of fistula <i>in ano</i>

Beckingham, I. J.; Spencer, J A; Ward, Janice; Dyke, Garry; Adams, Carl S.; Ambrose, N. S.

doi:10.1002/bjs.1800831022

Cited by 103 publications

(73 citation statements)

References 8 publications

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“…These findings were confirmed in a follow-up study of 35 patientsthat showed that interpretation of MR imaging was cor rect in 33 patients, including two cases in which examination under anesthesia had been unremarkable [12]. The largest study to date gave MR imaging a sensitivity of 97% and specificity of 100% for detection and classification of fistulas in 42 subjects, in whom four were incorrectly classified by ex amination under anesthesia [16].…”

Section: Mr Imaging Of Fistula In Anomentioning

confidence: 75%

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MR imaging of fistula in ano: are endoanal coils the gold standard?

Halligan¹,

Bartram²

1998

American Journal of Roentgenology

104

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OBJECTIVE. It hasbeen suggested that fistulain ano is mostaccuratelyassessed using endoanalreceivercoils becausethey providesuperiorspatialresolution.We aimed to deter mine their advantageby prospective comparisonwith conventional bodycoil imaging. SUBJECTS AND METHODS. Thirty consecutive unselectedpatientswith a diagnosis of anorectal sepsiswere examined by MR imaging with an endoanalcoil. Imaging with a body coil followed. Imaging was independently evaluatedby two radiologists who classified fistulas according to the coil used and then compared their findings, which were validated surgically.RESULTS. Five patientscouldnot toleratecoil insertion.In the remaining25 patients,en doanalimagingrevealedno abnormalitiesin threepatientsin whom the bodycoil imagecor rectly showed Crohn's disease, a sinus, and a transsphincteric fistula. Imaging with both coils revealedsepsisin 16patients, allowing radiologists to make correct primary track classification in 13patientson endoanal imagingcomparedwith 15patientson bodycoil imaging.Endoanal imagingrevealed10 secondaryextensionsin eight patients,but furtherextensionsin two of these patients and in a third patient were undetected.All theseextensions were seenon body coil imaging. Overall, surgical concordance was 68% for endoanal imaging compared with 96% for conventional bodycoil imaging.CONCLUSION. Due to field-of-view limitations,endoanalimagingis lessaccuratethan conventional body coil imaging for preoperative assessment of complex anal fistulas.

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Section: Mr Imaging Of Fistula In Anomentioning

confidence: 75%

“…However, accurateclassification usingthe bodycoil alreadyapproaches 100% [16], suggesting that more detailed imaging of the anal sphinctercomponentsis unnecessary. Furthermore, studies comparing endoanal MR imaging with surgical classification have found concordance to be only 64% [18].…”

Section: Mr Imaging Of Fistula In Anomentioning

confidence: 99%

MR imaging of fistula in ano: are endoanal coils the gold standard?

Halligan¹,

Bartram²

1998

American Journal of Roentgenology

104

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“…MRG'nin preoperatif kullanılması ve doğru fistül sınıflandırılmasının belirlenmesiyle önceden oldukça yüksek oranlarda görülen postoperatif rekürrens ve komplikasyon oranlarının azalmasını sağlamıştır [1,4,6].…”

Section: Discussionunclassified

“…MRG ile fistülün yaygınlığı ve uzanımları, apse varlığı, pelvik diyafram ve iskiorektal fossa ile ilişkisi, sfinkter komşulukları açık bir şekilde ortaya konulabilmektedir. Bunun sonucunda cerrahın tedavi başarısı giderek artmakta, rekürrens ve fekal inkontinans gibi komplikasyon oranları giderek azalmaktadır [1,4,[6][7][8].…”

Section: Introductionunclassified

Perianal fistülün tanısında, sınıflandırılmasında ve değerlendirilmesinde Manyetik Rezonans Görüntüleme’nin önemi

Koplay¹,

Sivri²,

Nayman³

et al. 2017

Archives of Clinical and Experimental Medicine

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Öz Amaç: Manyetik rezonans görüntüleme (MRG) perianal bölgenin değerlendirilmesinde yüksek güvenilirliğe sahip non-invaziv bir yöntemdir. Bu çalışmada, perianal fistül tanısı alan hastaların preoperatif MRG bulguları ve özellikle sınıflandırmanın görüntülerle birlikte sunulması amaçlandı. Yöntemler: Perianal fistül tanısı alan 57 hastanın demografik özellikleri ve kontrastlı konvansiyonel ve difüzyon MRG bulguları retrospektif olarak değerlendirildi. Perianal fistül sınıflandırılması MRG bulgularını temel alan 'St James Üniversite Hastanesi (SJUH) Sınıflaması' referans alınarak yapıldı. Bulgular: Çalışmaya 57 hasta (44 erkek ve 13 kadın: yaş aralığı 18-72 yıl; ortalama yaş 45,7 yıl) dahil edildi. Hastaların büyük çoğunluğunun esas yakınması makatta ağrı ve akıntı idi. Bazı hastalar ek olarak makatta kaşıntı, şişlik ve kızarıklık semptomları da bildirdi. 37 hastada tip 1, dokuz hastada tip 2, dört hastada tip 3, beş hastada tip 4, iki hastada ise tip 5 fistül saptandı. Anal kanala açılım yerleri 21 hastada saat 6, 10 hastada saat 7 olarak saptandı. Konvansiyonel ve difüzyon MRG ile fistül traktı, apse varlığı, rektuma açılım yeri, sfinkterle veya komşu anatomik yapılarla ilişkisi tüm hastalarda net olarak değerlendirildi. Sonuç: Anal kanal ve perine derisi arasında meydana gelen anormal bağlantı perianal fistül olarak adlandırılmaktadır. Genellikle tekrarlayan anorektal apselerin komplikasyonudur. Crohn, tüberküloz, malignite gibi inflamatuar süreçlere sekonder de gelişebilir. Tedavide esas yöntem cerrahidir. Cerrahi yetersizliğine bağlı rekürrens oldukça sıktır. MRG bulgularının iyi bilinmesi ve cerrahın iyi yönlendirilmesi ile rekürrens oranı en aza indirgenebilmektedir. Anahtar Kelimeler: Manyetik rezonans görüntüleme, Perianal fistül Abstract Aim: Magnetic resonance imaging (MRI) is a non-invasive and high reliability procedure for evaluation of perianal area. In this study, our purpose is to present preoperative MRI findings and classification with images in diagnosed perianal fistula patients. Methods: Contrast enhanced (CE) conventional MRI images, diffusion weighted MRI images and demographics of 57 patients were retrospectively evaluated. Perianal fistula classification is based on St James University Hospital (SJUH) classification system. Results: 57 patients (44 men and 13 women, average of 18 to 72 years, average age of 45.7 year) were included in this study. Most of the patients had symptoms of rectal pain and discharge. Some patients had additional complaints like rectal itching, swelling and erythema. 37 patients had grade 1, nine patients had grade 2, four patients had grade 3, five patients had grade 4 and two patients had grade 5 fistula. Fistula opening positions into anal canal were 6 o'clock in 21 patients, 7 o'clock in 10 patients. Fistula tract, its opening position into anal canal, presence of abscess and its relationship with sphincters or neighboring anatomical structures were clearly appreciated with conventional and diffusion weighted MRI in all patients. Conclusion: Perianal fistula i...

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“…Furthermore, radiologists can provide detailed anatomic descriptions of the relationship between the fistula and the anal sphincter complex, thereby allowing surgeons to choose the best surgical treatment, significantly reducing recurrence of the disease or possible secondary effects of surgery, such as fecal incontinence. 4,5 Aims and objectives 1. To study the usefulness MR imaging in perianal fistula.…”

Section: Introductionmentioning

confidence: 99%