A Diagnostic Accuracy Meta-analysis of Endoanal Ultrasound and MRI for Perianal Fistula Assessment

Siddiqui, Muhammed R; Ashrafian, Hutan; Tozer, Phil; Daulatzai, Najib; Burling, David; Hart, Ailsa; Athanasiou, Thanos; Phillips, R. K. S.

doi:10.1097/dcr.0b013e318249d26c

Cited by 188 publications

(122 citation statements)

References 44 publications

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“…We did not look at sensitivity or specificity in diagnosis of fistula-in-ano. A recent metaanalysis looking into this from 2012 found the degree of heterogeneity between studies to be high, with sensitivities being reported as between 0.63 to 0.93, while the figures for specificity were 0.51 to 0.82 [24] . The numbers of sequences that could be employed are many, with several that were not assessed by us.…”

Section: A B a Bmentioning

confidence: 99%

Comparison of different magnetic resonance imaging sequences for assessment of fistula-in-ano

Torkzad¹,

Åhlström²,

Karlbom³

2014

WJR

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AIM:To assess agreement between different forms of T2 weighted imaging (T2WI), and post-contrast T1WI in the depiction of fistula tracts, inflammation, and internal openings with that of a reference test. METHODS:Thirty-nine consecutive prospective cases were enrolled. The following sequences were used for T2WI: 2D turbo-spin-echo (2D T2 TSE); 3D T2 TSE; short tau inversion recovery (STIR); 2D T2 TSE with fat saturation performed in all patients. T1WI were either a 3D T1-weighted prepared gradient echo sequence with fat saturation or a 2D T1 fat saturation [Spectral presaturation with inversion (SPIR)]. Agreement for each sequence for determination of fistula extension, internal openings, and the presence of active inflammation was assessed separately and blindly against a reference test comprised of follow-up, surgery, endoscopic ultrasound, and assessment by an independent experienced radiologist with access to all images. RESULTS:Fifty-six fistula tracts were found: 2 intersphincteric, 13 trans-sphincteric, and 24 with additional tracts. The best T2 weighted sequence for depiction of fistula tracts was 2D T2 TSE (Cohen's kappa = 1.0), followed by 3D T2 TSE (0.88), T2 with fat saturation (0.54), and STIR (0.19). Internal openings were best seen on 2D T2 TSE (Cohen's kappa = 0.88), followed by 3D T2 TSE (0.70), T2 with fat saturation (0.54), and STIR (0.31). Detection of inflammation showed Cohen's kappa of 0.88 with 2D T2 TSE, 0.62 with 3D T2 TSE, 0.63 with STIR, and 0.54 with T2 with fat saturation. STIR, 3D T2 TSE, and T2 with fat saturation did not make any contributions compared to 2D T2 TSE. Post-contrast 3D T1 weighted prepared gradient echo sequence with fat saturation showed better agreement in the depiction of fistulae (Cohen's kappa = 0.94), finding internal openings (Cohen's kappa = 0.97), and evaluating inflammation (Cohen's kappa = 0.94) compared to post-contrast 2D T1 fat saturation or SPIR where the corresponding figures were 0.71, 0.66, and 0.87, respectively. Comparing the best T1 and T2 sequences showed that, for best results, both sequences were necessary. CONCLUSION: 3D T1 weighted sequences were best for the depiction of internal openings and active inflammatory components, while 2D T2 TSE provided the best assessment of fistula extension. Key words: Fistula; Magnetic resonance imaging; Diagnosis Core tip: Both T1 (post-contrast) and T2 weighted sequences are needed for the best assessment of fistulain-ano; T2 weighted imaging: 2D turbo-spin-echo (2D T2 TSE) is most useful for depiction in relation to sphincter muscles. 3D T2 TSE cannot replace 2D T2 TSE. Post-contrast 3D T1 weighted prepared gradient echo sequence with fat saturation is necessary for the CASE CONTROL STUDY

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Section: A B a Bmentioning

confidence: 99%

Comparison of different magnetic resonance imaging sequences for assessment of fistula-in-ano

Torkzad¹,

Åhlström²,

Karlbom³

2014

WJR

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“…La principal indicación de la endosonografía fue incontinencia fecal, con una mayoría de población femenina, lo cual está en relación con la literatura mundial (12)(13)(14)(15)(16); también es congruente que en las mujeres con indicación del estudio por incontinencia predominó la historia de desgarro obstétrico. En su estudio descriptivo, López-Kôstner y colaboradores (4) obtuvieron como principal indicación de endosonografía anorrectal, la incontinencia fecal, presentándose en 336 pacientes de 1000 (33,6%); muy en relación con nuestro reporte, donde fue de 44%.…”

Section: Discussionunclassified

Hallazgos en endosonografía anorrectal en una cohorte prospectiva

Ferreira

Vásquez

et al. 2016

Rev. Colomb. Gastroenterol.

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La endosonografía anorrectal permite diagnosticar múltiples patologías del canal anal y del recto. En Colombia se realiza en pocos sitios y es escaso el personal entrenado para ello. Un grupo de docentes de gastroenterología clínica quirúrgica de la Universidad de Caldas recibió entrenamiento en endosonografía anorrectal en Chile y España, después de lo cual inició su trayectoria, ya de 4 años. Con los datos del último año se realizó un estudio descriptivo en una cohorte prospectiva, tomando la información de los pacientes a quienes se les realizó endosonografía anorrectal entre octubre de 2014 y septiembre de 2015. Se obtuvieron datos de 136 pacientes, predominando el género femenino (72,05%); el 20,6% de los pacientes procedían de departamentos diferentes a Caldas. La principal indicación fue incontinencia fecal en 44 pacientes (32,35%), siendo 86% mujeres; otras indicaciones fueron neoplasia maligna rectal (23,5%), fístula perianal (12,5%), proctalgia (11,03%), endometriosis (7,35%) y absceso perianal (6,62%). El diagnóstico final más frecuente fue defecto de los esfínteres en 40 pacientes (29,41%), seguido por neoplasia maligna rectal (13,24%), fístula perianal (11,76%), absceso perianal (8,82%) y neoplasia benigna rectal (6,62%). Los resultados están en congruencia con la literatura mundial, donde la principal indicación es la incontinencia fecal en relación con el diagnóstico final, que es defectos de los esfínteres por alteraciones obstétricas.La endosonografía anorrectal es de gran importancia como método diagnóstico único o de apoyo para otros, con centros de referencia como el nuestro, donde se realiza en un volumen importante y siguiendo las pautas internacionales recomendadas.

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“…Several imaging modalities, as the Endoanal Ultrasound, fistulography, CT and MRI, allow the visualization of perianal fistulas [6][7][8][21][22][23][24][25][26][27][28][29]. Among these, endoanal ultrasound provides a good visualization of the intersphincteric plane and the perianal and perirectal soft tissue and is used in the assessment of patients with suspected perianal sepsis, but cannot distinguish areas of fibrosis from the active areas of inflammation and is inadequate for evaluation of ischioanal fossa and supraelevator region [21,24].…”

Section: Discussionmentioning

confidence: 99%