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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Available from: Tomasz Adamczyk, Oct 04, 2015
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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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    ABSTRACT: A 7-year-old Quarter Horse gelding was referred for magnetic resonance (MR) imaging due to chronic left hindlimb lameness localised to the foot. On presentation, a previously undiagnosed draining tract was identified at the plantar aspect of the pastern. Radiographs revealed severe osteolysis of the navicular bone. Positive contrast MR fistulography was performed using a gadolinium based contrast agent following conventional MR imaging of the left hind foot. Fistulography allowed characterisation of a fistulous tract, which was closely associated with the deep digital flexor tendon, navicular bursa and osteomyelitis of the navicular bone.
    01/2014; 26(1). DOI:10.1111/eve.12004
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    ABSTRACT: Aim of the work To evaluate the role of magnetic resonance imaging (MRI) in preoperative assessment of ano-rectal fistula and tracing its full extent and relationship. Materials and methods Twenty-four patients with ano-rectal fistula were enrolled in this study. They were examined with different MRI sequences for evaluation of the fistulas and their extent. Fistulas were classified according to St. James’s University Hospital MRI based classification system (which correlates the Parks surgical classification to anatomic MRI findings) into 5 grades. Then, interrelation between surgical and MRI findings was statistically analyzed with evaluation of the accuracy of each MRI sequence used. Results Grade 1 was the most frequent (37.5%) type of ano-rectal fistula. The most common location of the internal opening of the fistula was at 6 o’clock position. Combination of oblique coronal and axial planes of contrast-enhanced fat suppressed T1-weighed fast spin-echo (CE FS T1WFSE) sequence images showed the highest accuracy (99.4%) in diagnosis of ano-rectal fistula. Conclusion MRI is a useful imaging tool in the preoperative assessment of ano-rectal fistula. A significant accordance between surgical and MRI findings was achieved by using combination of coronal and axial planes of CE FS T1WFSE sequence images.
    Egyptian Journal of Radiology and Nuclear Medicine 01/2013; 45(1). DOI:10.1016/j.ejrnm.2013.10.008
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    ABSTRACT: Background Perianal fistulas are malformations of the anorectal area. Accurate preoperative assessment of perianal fistula tract is a main assumption in diagnosis of the disease, affecting the operation efficiency. The aim of the study was to present our experience in application of a new diagnostic protocol based on the magnetic resonance imaging (MRI) examination using a mixture of hydrogen peroxide (HP) and gadolinium as a direct contrast medium in evaluation of recurrent fistulas tract. The method is referred to as HPMRI. Material/Methods The study group consisted of 12 subjects operated on from 2011. Direct HPMRI fistulography was performed in all subjects before the operation. All types of fistulas were precisely evaluated by HPMRI examination. Results Intraoperative state confirmed complete course of fistulas in 11 cases. In 1 case, an internal opening was not found. Conclusions We suggest that this new method of direct HPMRI fistulography may improve visualization of the tracts of recurrent fistulas and improve efficacy of surgical procedures.
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