Usefulness assessment of preoperative MRI fistulography in patients with perianal fistulas

Department and Clinic of General and Gastroenterological Surgery of Medical University of Silesia in Katowice, Bytom, Poland.
Polish journal of radiology / Polish Medical Society of Radiology 10/2011; 76(4):40-4.
Source: PubMed


Accurate preoperative assessment of the perianal fistulous tract is the main purpose of the diagnostics and to a large extend determines surgery effectiveness. One of the useful diagnostic methods in perianal fistulas is magnetic resonance imaging. The authors presented experiences in the application of MRI fistulography for evaluation of cases of perianal fistulas difficult to diagnose and treat.
Own examination method was described; MRI fistulography findings were analyzed and compared with intraoperative conditions in 14 patients (11 men and 3 women) diagnosed in the years 2005- 2009. Eight patients had recurrent fistulas and 6 had primary fistulas. Imaging was performed with a GE SIGNA LX HS scanner with a 1.5-Tesla field strength and a dedicated surface coil placed at the level of hip joints. Contrast agent was a gadolinium-based solution.
Intraoperative findings were consistent with radiological descriptions of 13 MRI fistulographies. Only in one case, according to surgery findings, it was a transsphincteric fistula with an abscess in the ischioanal fossa, with an orifice in the posterior crypt; the radiologist described it as a transsphincteric, internal blind fistula.
Due to its accuracy in the assessment of the perianal fistulous tracts in soft tissues, MRI fistulography becomes a useful and recommended diagnostic method in this pathology. It shows the location of the fistula regarding the system of anal sphincters, and identifies the internal orifice and branching of the fistula. It enables precise planning of surgical treatment. Authors suggest that this diagnostic method should be improved and applied more commonly.

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    • "We found a similar improved ability to identify the fistula following contrast administration in our study using a 3D T1W GRE sequence. Magnetic resonance fistulography has been described more commonly in man for perianal and anovaginal fistulae (Sabir et al. 2000; Ergen et al. 2007; Waniczek et al. 2011). Post contrast T2W GRE, and to a lesser extent precontrast STIR sequences, provided the greatest ability to identify perianal fistulous tracts using gadolinium enhanced fistulography with MRI (Sabir et al. 2000). "
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