Added value of diffusion-weighted magnetic resonance imaging for the diagnosis of perianal fistula

Çavuşoğlu, Mehtap; Duran, Semra; Cılız, Deniz; Tufan, Gulnihal; Çeti̇n, Hüseyin; Özsoy, Arzu; Sakman, Bülent

doi:10.1016/j.diii.2016.11.002

Cited by 24 publications

(21 citation statements)

References 22 publications

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“…DW imaging has therefore been proposed as an important alternative, owing to the fact that inflammatory lesions can be seen as high signal areas on DW imaging. The fistulous tracks appear hyperintense while the background signal is significantly suppressed on DW images; thus, the presence and extent of fistula can be detected clearly [23,35]. Studies have concluded that the conspicuity of fistulous tracks is better on DW-MRI than T2W images, thus increasing the sensitivity for its detection [23,35,36].…”

Section: Magnetic Resonance Imaging (Mri)mentioning

confidence: 99%

Current imaging techniques for evaluation of fistula in ano: a review

Sharma

Yadav

Sahu

et al. 2020

Egypt J Radiol Nucl Med

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Background: Fistula in ano is one of the common anorectal disorders which have a tendency to recur specially in complex cases usually due to missed or undetected sepsis at the time of examination or surgery. A correct identification of the primary source of crypt infection along with a complete understanding of the anatomical course of primary and secondary tracks and abscesses is a prerequisite for the successful management of fistula. Preoperative evaluation of fistula in ano using radio-imaging techniques provides a handy insight of fistula anatomy and helps in planning the appropriate treatment strategy. The objective of this article is to review the role of different radio-imaging techniques in the diagnosis and evaluation of fistula in ano along with their advantages and disadvantages over one another. Main text: A comprehensive literature review was performed searching through the electronic databases as well as the standard textbooks of colorectal surgery. X-rays (plain radiographs and contrast fistulography), computed tomography (CT) scanning, anal endosonography, and magnetic resonance (MR) imaging are the modalities used for preoperative imaging of fistula in ano. Due to low accuracy, X-ray fistulography is not used now for fistula imaging. CT fistulography can be more accurate in cases associated with acute inflammations and abscesses and the fistulas related with inflammatory bowel disease. Anal endosonography and MRI are two of the mostly used and reliable imaging techniques for fistula in ano. Though the use of a 3D technology has improved the accuracy of anal endosonography, MRI is the preferred choice by many. However, various reports have depicted comparable accuracies for both MRI and anal endosonography showing both to be equally sensitive but MRI to be more specific. 3D endoanal ultrasound, on the other hand, is more rapid and can also be used intraoperatively to provide live imaging during surgical exploration. Conclusion: Complex and recurrent fistula cases should undergo a preoperative imaging to reduce the chances of recurrence. MRI is recommended as the imaging modality of choice for such cases. 3D anal endosonography may however be a good option over MRI owing to its rapidity, availability, and potential of intraoperative assistance during surgery.

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Section: Magnetic Resonance Imaging (Mri)mentioning

confidence: 99%

Current imaging techniques for evaluation of fistula in ano: a review

Sharma

Yadav

Sahu

et al. 2020

Egypt J Radiol Nucl Med

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“…These findings go in hand with Dohan et al [22] who reported an area under the ROC curve of 0.971 with a sensitivity of 100%, a specificity of 90 %, PPV of 93%, and NPV of 90% for an abscess diagnosis. Also, Cavusoglu et al [23] found the confidence scores for perianal fistula diagnosis using combination of gadolinium chelate-enhanced T1 and T2-WI were greater than T2-WI alone and confidence scores using the combination of DW-MRI and T2-WI were greater than T2-WI alone with greater sensitivity and specificity.…”

Section: Discussionmentioning

confidence: 99%

“…Then, Yoshizako et al [21] who assessed the feasibility of using DW-MRI for evaluating perianal fistula activity documented that DW-MRI is a feasible method for evaluating perianal fistula activity with area under the ROC curve of 0.749. Thereafter, Cavusoglu et al [23] documented that DW-MRI has a significant added value compared to T2-WI alone in the diagnosis of perianal fistula and Baik et al [24] found combined DW-MRI and CE-T1WI might improve fistula conspicuity with comparable diagnostic performance to T2WI. Recently, Wang et al [25] reported that fractional anisotropy (FA) and ADC values for positive inflammation activity were significantly lower than those for negative inflammatory activity and concluded that FA and ADC values were instrumental in evaluating the activity of perianal fistulas.…”

Section: Discussionmentioning

confidence: 99%

Preoperative MRI of perianal fistula evaluation and its impact on surgical outcome

Algazzar

Eldib

Zaher

2019

Egypt J Radiol Nucl Med

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Background: Perianal fistula (PAF) is an abnormal tract communicating an external cutaneous opening in the perianal region to the anal canal. PAF is one of the common anorectal disorders in surgical practice with high prevalence. The current study aimed to determine the ability of preoperative MRI for preoperative evaluation of perianal fistula. Results: This is a retrospective evaluation of 65 patients with perianal fistula. MRI fistula imaging-related data were revised, and fistula severity was scored using criteria of both local extension of fistulas and active inflammation for a total maximum score of 22. Preoperative MRI could predict the severity of perianal disease with sensitivity, specificity, and accuracy rates of 75%, 92%, and 84.6%, respectively. Surgical findings concerning PAF severity correlated significantly with MRI findings. Diffusion-weighted magnetic resonance imaging (DW-MRI) provided high sensitivity and accuracy with 100% specificity for fistula visualization and highest sensitivity, specificity, and accuracy for detection of cavities > 3 mm in diameter. DW-MRI provided the highest specificity rate on ROC curve analysis among the three MRI pulse sequences (DW-MRI, short tau inversion recovery (STIR), and T1 post-contrast). Conclusion: MRI is valuable and accurate for preoperative investigation for PAF evaluation and abscess localization. MRI allowed accurate detection of internal fistula opening and its relation to sphincters. DW-MRI is a valuable sequence with highest diagnostic yield, and its addition to STIR WI improves sensitivity and specificity for determination of fistula activity and extension.

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“…In MRI pelvis, T1 weighted, T2 weighted, short tau inversion recovery (STIR) and T1 post-contrast with fat suppression sequences are commonly used to evaluate fistula-in-ano [10]. Recently, the role of diffusion-weighted imaging (DWI) has also been evaluated [11]. However, MRI is an expensive modality and is time-consuming to perform.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of Short Tau Inversion Recovery as a Limited Protocol for Diagnosing Perianal Fistula

Jabeen

Qureshi

Sattar

et al. 2019

Cureus

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Added value of diffusion-weighted magnetic resonance imaging for the diagnosis of perianal fistula

Abstract: DWI has a significant added value compared to T2-weighted imaging alone in the diagnosis of perianal fistula.

Cited by 24 publications

References 22 publications

Current imaging techniques for evaluation of fistula in ano: a review

Current imaging techniques for evaluation of fistula in ano: a review

Preoperative MRI of perianal fistula evaluation and its impact on surgical outcome

Diagnostic Accuracy of Short Tau Inversion Recovery as a Limited Protocol for Diagnosing Perianal Fistula

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