Comparative study of MRI fistulogram and X-ray fistulography with operative findings: in fistula in ano

Nishant Tripathi, Shahaji Chavan, Mahendra Bendre, Vishal Sharma


Background: The current study has attempted to evaluate the effectiveness and diagnostic accuracy of MRI fistulogram over X-ray fistulography by comparing their findings with intraoperative findings.

Methods: A hospital based prospective study was conducted at Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune with 60 patients to compare the findings of MRI fistulogram and X-ray fistulography with operative finding in fistula in ano. The study was carried out with following two groups of 30 patients each. Group A -30 cases underwent MRI fistulogram. Group B: 30 cases had done X-ray fistulography. Its findings were compared with the final findings of the operation.

Results: On evaluation of the intra-operative findings with MRI fistulogram, we found that inter-sphincteric fistulous tract were noted in 23 patients as compared to 22 patients detected by MRI. In the rest of the findings the sensitivity of MRI with intraoperative findings was nearly 100% with a significant correlation. Sensitivity and specificity of X-ray fistulogram for fistula in ano was very low.

Conclusions: The results have been statistically significant in providing data in favour of MRI fistulogram as diagnostically superior to X-ray fistulography.


MRI fistulogram, X-ray fistulography, Fistula

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Thorson AG, Beaty JS. Diverticular disease. The ASCRS Textbook of Colon and Rectal Surgery. New York: Springer; 2011:375-393.

Corman ML. Anal Fistula. Colon & Rectal Surgery. 5th ed. Chapter 11. Philadelphia, Pa: Lippincott Williams & Wilkins; 2005.

Belliveau P. Anal fistula. Current Therapy in Colon and Rectal Surgery. Philadelphia: BC Decker; 1990: 22-27.

Hussain SM, Stoker J, Laméris JS. Anal sphincter complex: endoanal MR imaging of normal anatomy. Radiology. 1995;197(3):671-7.

Gage KL, Deshmukh S, Macura KJ, Kamel IR, Zaheer A. MRI of perianal fistulas: bridging the radiological–surgical divide. Abdominal imaging. 2013;38(5):1033-42.

Mohamed RE, Abo-Sheisha DM. Role of magnetic resonance imaging in pre-operative assessment of ano-rectal fistula. The Egyptian Journal of Radiology and Nuclear Medicine. 2014;45(1):35-47.

Ratto C, Gentile E, Merico M, Spinazzola C, Mangini G, Sofo L, Doglietto G. How can the assessment of fistula-in-ano be improved?. Diseases of the colon & rectum. 2000;43(10):1375-82.

Farquharson M, Surgery of Anus & perineum. In: Margaret Farquharson, James Hollingshead, Brendan Moran (eds.). Chapter 24. Farquharson’s Textbook of Operative General Surgery. 10th Edition. FL: Taylor & Francis Group; 2015: 446-44

Panda SK, Panigrahi M. A study on magnetic resonance imaging fistulogram evaluation of perianal discharge in an Indian population. Asian J Pharm Clin Res. 2018;11(5):284-9.

Sofic A, Beslic S, Sehovic N, Caluk J, Sofic D. MRI in evaluation of perianal fistulae. Radiol Oncol. 2010;44(4):220-7.

Sainio P. Fistula-in-ano in a defined population. Incidence and epidemiological aspects. Ann Chir Gynaecol. 1984;73:219-24.

Jordán J, Roig JV, García-Armengol J, et al. Risk factors for recurrence and incontinence after anal fistula surgery. Colorectal Dis. 2010;12:254–60.

Lunnis PJ, Barker PG ,Sultan AH, et al. Magnetic resonance imaging of fistula in ano. Dis colon Rectum. 1994;37(7):708-18.

Buchanan G, Halligan S, Williams A, et al. Effect of MRI on clinical outcome of recurrent fistula in ano. Lancet. 2002;360(9346):1661-2.

Lilus HG. Fistula –in-ano, an investigation of human foetal anal ducts and intramuscular glands and a clinical study of 150 patients. Acta Chir Scand.1968;383:7-88.

Beckingham IJ, Spencer JA, Ward J, Dyke GW, Adams C, Ambrose NS. Prospective evaluation of fistula in ano. Br J Surg. 1996;83(10):1396-8.