Magnetic resonance imaging for fistulography in perianal fistula: clinicoradiological correlation
DOI:
https://doi.org/10.18203/2349-2902.isj20222094Keywords:
MR fistulography, Perianal Fistula, ConcordanceAbstract
Background: This article aims to review the role of magnetic resonance imaging (MRI) fistulography in evaluation of perianal fistula along with its concordance with clinical examination and impact on surgical intervention.
Methods: A retrospective study of 61 patients who underwent surgery for anal fistula in RMLIMS collected from database from January 1, 2017 to September, 2021
Results: The study showed a significant MRI contribution to clinical evaluation in 65.6%. MRI provided significant information for complex fistulas than for simple fistulas (45% vs. 14.6%, p=0.01). Proportion of patients with significant MRI contribution increased with increasing Parks grade (grade 1, 8.3%; grade 2, 52.2%, p=0.001). The concordance between St. James Hospital grade and Parks classification was 0.768 (Kappa coefficient, p<0.00).
Conclusions: Therefore, we propose inclusion of MRI in the preoperative surgical assessment of anal fistulas when recurrent, complex, high grade, or when the external opening is located more than 2 cm from the anal canal.
Metrics
References
Seow-Choen F, Nicholls RJ. Anal fistula. Br J Surg. 1992;79(3):197-205.
Igwe PO, Dodiyi-Manuel A, Oparaku KC. The pattern of surgically treatable anorectal diseases in University of Port Harcourt Teaching Hospital, Rivers State, Nigeria. Niger J Med. 2014;23(1):57-60.
Felt-Bersma RJ, Bartelsman JF. Haemorrhoids, rectal prolapse, anal fissure, peri-anal fistulae and sexually transmitted diseases. Best Pract Res Clin Gastroenterol. 2009;23(4):575-92.
Sheikh P, Baakza A. Management of fistula-in-ano-the current evidence. Indian J Surg. 2014;76(6):482-6.
Vasilevsky CN, Gordon PH. Benign anorectal: abscess and fistula. In: Wolff BG, Fleshman JW, Beck DE, Pemberton JH, Wexner SD (eds) The ASCRS textbook of colon and rectal surgery. Springer Science and Business Media, New York. 2007;192-202.
Parks AG, Gordon PH, Hardcastle JD. A classification of fistula in ano. Br J Surg. 1976;63:1-12.
Whiteford MH, Kilkenny J 3rd, Hyman N. Practice parameters for the treatment of peri¬anal abscess and fistula-in-ano (revised). Dis Colon Rectum. 2005;48:1337-42.
Williams JG, Farrands PA, Williams AB, Taylor BA, Luniss PJ, Sagar PM et al. The treatment of anal fistula: ACPGBI Position Statement. Colorectal Dis. 2007; 9(4):18-50.
Pomerri F, Pittarello F, Dodi G, Pianon P, Muzzio PC. Radiologic diagnosis of anal fistulae with radio-opaque markers. Radiol Med. 1988;75(6):632-7.
D'Hoore A, Penninckx F. The pathology of complex fistula in ano. Acta Chir Belg. 2000;100(3):111-4.
Di Nardo R, Drudi FM, Marziale P, Iannicelli E, Righi A, Trippa F et al. Role of color Doppler echography in the visualization of perianal fistulae with injections of physiologic solutions. Radiol Med. 2000;100(4):235-9.
Kim MJ. Transrectal ultrasonography of anorectal diseases: advantages and disadvantages. Ultrasonography. 2015;34(1):19-31.
Bor R, Farkas K, Bálint A, Szűcs M, Ábrahám S, Milassin Á et al. Prospective comparison of magnetic resonance imaging, transrectal and transperineal sonography, and surgical findings in complicated perianal Crohn disease. J Ultrasound Med. 2016;35(11):2367-72.
Lunniss PJ, Armstrong P, Barker PG, Reznek RH, Phillips RK. Magnetic resonance imaging of anal fistulae. Lancet. 1992;340:394-6.
Zbar AP, Armitage NC. Complex perirectal sep¬sis: clinical classification and imaging. Tech Col-oproctol 2006;10:83-93.
Morris J, Spencer JA, Ambrose NS. MR imaging classification of perianal fistulas and its implications for patient management. Radiographics: a review. Radiological Society N Am. 2000;20:623-35.
Singh K, Singh N, Thukral C, Singh KP, Bhalla V. Magnetic resonance imaging (MRI) evaluation of perianal fistulae with surgical correlation. J Clin Diagnostic Res. 2014;8:RC01.
Torkzad MR, Ahlström H, Karlbom U. Comparison of different magnetic resonance imaging sequences for assessment of fistula-in-ano. World J Radiol. 2014;6:203.
Buchanan GN, Halligan S, Bartram CI, Williams AB, Tarroni D, Cohen CR. Clinical examination, endosonography, and MR imaging in preoper¬ative assessment of fistula in ano: comparison with outcome-based reference standard. Ra¬diology. 2004;233:674-81.
Halligan S, Stoker J. Imaging of fistula in ano. Radiology. 2006;239:18-33.
Colon TSPTFASo, Surgeons R. Practice param-eters for treatment of fistula-in-ano. Dise Colon Rectum. 1996;39:1361-72.
Maier AG, Funovics MA, Kreuzer SH. Evalu¬ation of perianal sepsis: comparison of anal en-dosonography and magnetic resonance imag¬ing. J Magn Reson Imaging. 2001;14:254-60.
Sahni VA, Ahmad R, Burling D. Which method is best for imaging of perianal fistula? Abdom Imaging. 2008;33:26-30.
Garg P, Singh P, Kaur B. Magnetic resonance im-aging (MRI): operative findings correlation in 229 fistula-in-ano patients. World J Surg. 2017;41:1618-24.
Beets-Tan RG, Beets GL, van der Hoop AG. Preoperative MR imaging of anal fistulas: Does it really help the surgeon? Radiology. 2001;218:75-84.
Sofic A, Beslic S, Sehovic N, Caluk J, Sofic D. MRI in evaluation of perianal fistulae. Radiol Oncol. 2010;44:220-27.
Schaefer O, Lohrmann C, Langer M. Assess¬ment of anal fistulas with high-resolution sub¬traction MR-fistulography: comparison with surgical findings. J Magn Reson Imaging. 2004;19:91-8.
Spencer JA, Chapple K, Wilson D, Ward J, Wind-sor AC, Ambrose NS. Outcome after surgery for perianal fistula: predictive value of MR imag¬ing. AJR Am J Roentgenol. 1998;171:403-6.
Abou-Zeid AA. Anal fistula: intraoperative diffi-culties and unexpected findings. World J Gas-troenterol. 2011;17:3272-6.