Abstract
BackgroundPerianal fistula (PAF) is an abnormal tract communicating an external cutaneous opening in the perianal region to the anal canal. PAF is one of the common anorectal disorders in surgical practice with high prevalence. The current study aimed to determine the ability of preoperative MRI for preoperative evaluation of perianal fistula.ResultsThis is a retrospective evaluation of 65 patients with perianal fistula. MRI fistula imaging-related data were revised, and fistula severity was scored using criteria of both local extension of fistulas and active inflammation for a total maximum score of 22. Preoperative MRI could predict the severity of perianal disease with sensitivity, specificity, and accuracy rates of 75%, 92%, and 84.6%, respectively. Surgical findings concerning PAF severity correlated significantly with MRI findings. Diffusion-weighted magnetic resonance imaging (DW-MRI) provided high sensitivity and accuracy with 100% specificity for fistula visualization and highest sensitivity, specificity, and accuracy for detection of cavities > 3 mm in diameter. DW-MRI provided the highest specificity rate on ROC curve analysis among the three MRI pulse sequences (DW-MRI, short tau inversion recovery (STIR), and T1 post-contrast).ConclusionMRI is valuable and accurate for preoperative investigation for PAF evaluation and abscess localization. MRI allowed accurate detection of internal fistula opening and its relation to sphincters. DW-MRI is a valuable sequence with highest diagnostic yield, and its addition to STIR WI improves sensitivity and specificity for determination of fistula activity and extension.
Highlights
Perianal fistula (PAF) is an abnormal tract communicating an external cutaneous opening in the perianal region to the anal canal
All patients who presented with clinically suspected PAF and signed fully informed written consent to undergo the appropriate surgical procedure for fistula management were included in the preliminary data evaluation
Considering identification of internal fistula opening is mandatory to define fistula tract; otherwise, it is considered as pouch, and Magnetic resonance imaging (MRI) defined 9 patients having pouches without definite internal opening, while the remaining 56 patients had definite internal opening; 10 patients had branched and 46 patients had unbranched fistula
Summary
Perianal fistula (PAF) is an abnormal tract communicating an external cutaneous opening in the perianal region to the anal canal. PAF is one of the common anorectal disorders in surgical practice with high prevalence. Perianal fistula (PAF) is an abnormal tract communicating an external cutaneous opening in the perianal region to an internal opening, most often in the anal canal [1]. PAF is one of the common anorectal disorders in surgical practice [2] with high prevalence, which predominantly affects young adult males [3]. Various radiological modalities were applied for evaluation of fistula patients; conventional fistulography was used [9] but its diagnostic yield is limited secondary to its difficulty to recognize the internal opening especially if blocked by debris [10]. Endosonography with color Doppler has greater diagnostic value than conventional grayscale endosonography for PAF evaluation [11]
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