Abstract
Indirect Magnetic Resonance Fistulography: A New Gold Standard in Diagnosing Perianal Fistulas? Comparative Studies Purpose: The aim of this prospective study was to establish a feasible MR imaging protocol in the detection of perianal fistulas. For this purpose a conventional sequence protocol was compared with 3D-gradient echo imaging. Material and Methods: A T1-weighted FLASH- 3D sequence before and after i.v. contrast medium application and image subtraction was tested against a fatsaturated postcontrast T1-weighted spin echo sequence in the axial plane. Levels of significance were analysed upon 5 criteria. Results: In the comparative study the contrast-enhanced FLASH-3D-sequence after image subtraction revealed internal openings in 8 cases (48%), external openings in 16 cases (100%), and the fistulous tract in all patients (100%). Abscess formations were detected in 11 cases (66%) and secondary fistulous tracts were seen in 9 patients (54%). In the McNemar test, significant differences between FLASH-3D sequence and T1- weighted spin echo sequence exist concerning the detection of an internal opening and secondary fistulous tracts (p < 0.1). Conclusion: Our results demonstrate that the contrast-enhanced 3D-gradient echo technique is superior to conventional MR imaging protocols in the detection of perianal fistulas.
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