Magnetic resonance imaging in the workup of patients with perianal fistulas

Abstract Background Perianal sepsis and fistulas are common lesions. Fistula-in-ano is a tedious problem because of high recurrence rates severe unexpected complications postoperatively. Many imaging modalities used to evaluate this area. Magnetic resonance (MRI) has been considered the gold standard procedure for perianal fistula assessment, i.e., it provides surgeon with an accurate roadmap select best surgical approach, determines extent sphincter division, estimates risk postoperative incontinence. We carried out prospective diagnostic accuracy study involving 50 patients (mean age, 42.44 years) who underwent pelvic MRI 1.5 Tesla scanner using multiple sequences, including diffusion post-contrast series that were either local or systemic. This aimed validity MRI/MR fistulogram in identify fistula-associated findings by MRI, optimize technique maximum technical safety. Results Intersphincteric most type observed based on Parks’ classification. Intersphincteric, trans-sphincteric, extrasphincteric, suprasphincteric found 30 (60%), 12 (24%), 4 (8%), (8%) patients, respectively. According St. James’ classification, 21 (42%), 9 (18%), 8 (16%), (16%) had grades I, II, III, IV, V, The combination variable MR sequences increased examinations. Our results correlated (reference standard) perfect interobserver reliability. Conclusions Of all modalities, become prerequisite successful surgery fistula. can identify: (a) morphological details, (b) relationship between fistulous tract anal sphincter, (c) wound healing, (d) active versus chronic scarred fistula, (e) stigmata, (f) from its mimics. combinations increase efficiency safety avoiding both ionizing radiation systemic gadolinium.