Diffusion-weighted imaging in the evaluation of perianal fistula and abscess

Mohsen, Laila; Osman, Nasr Mohamed M.

doi:10.1186/s43055-020-00193-3

Cited by 6 publications

(8 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our study sample, the visibility scores of the combined DWI-T2W images overcome the visibility score on DWI, T2W and CEMRI images shown in Table 2 .The findings of our study sample are comparable with the previous study conducted by Mohsen and Osman. 12 …”

Section: Discussionmentioning

confidence: 99%

“…Score 0 = no evident fistula, 1 = probably present fistula, and 2 = distinctly present fistula. 12 To know the diagnostic performance of DWI in the evaluation of perianal fistula, the imaging findings of the fistula were determined on DWI, T2W, combined T2W-DWI images, and CEMRI. As a reference for grading perianal fistula, the combined T2W-CEMRI (contrast enhanced MR) images were used.…”

Section: Methodsmentioning

confidence: 99%

“…11 A study by Mohsen and Osman observed a preoperative accuracy of 97.8% for detecting and classifying perianal fistulae with combined DWI and T2W sequences. 12 Cavusoglu et al 13 showed a sensitivity of 72-79% and specificity of 100% for preoperative detection of perianal fistula with T2W images alone, while combined DWI and T2W sequences showed sensitivity of 96 to 100% and specificity of 100%. Previously published studies also showed the difference of mean ADC values between the active and inactive fistulas.…”

Section: Introductionmentioning

confidence: 97%

“…Previously published studies also showed the difference of mean ADC values between the active and inactive fistulas. 3 8 12 14 …”

Section: Introductionmentioning

confidence: 99%

“…Previously published studies also showed the difference of mean ADC values between the active and inactive fistulas. 3,8,12,14 The present study was conducted to evaluate the role of diffusion-weighted MRI in the evaluation of perianal fistulae.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Role of Diffusion-Weighted Imaging in the Evaluation of Perianal Fistulae

Boruah

Hazarika

Ahmed

et al. 2021

Indian Journal of Radiology and Imaging

View full text Add to dashboard Cite

Background Magnetic resonance imaging (MRI) is the imaging modality of choice for evaluating perianal fistulae, due to its ability to show the relationship of perianal fistulae with anal sphincters, fistula extensions, secondary ramifications and associated complications. Aim To evaluate the role of diffusion-weighted MRI in the evaluation of perianal fistulae. Settings and Design A hospital-based cross-sectional study. Materials and Methods The study group composed of 47 patients of perianal fistula. MRI with diffusion-weighted imaging (DWI) was performed with Philips 0.5 T Ingenia scanner. DWI with different b-values (b = 50, b = 400, and b = 800 smm2) were obtained. The MRI findings were correlated with local clinical examination and or surgical findings. Statistical Analysis Used Chi-square test, independent samples t-test, and receiver operating characteristic curve analysis. Result Fifty-nine perianal fistulas in 47 patients were included in the study sample. The visibility of perianal fistula on DWI was less than T2-weighted (T2W) and combined DWI-T2W images. Distinctly visualized (visibility score 2) perianal fistulas were observed in 47 fistulas (79.6%) on DWI, 54 (91.5%) on T2W, and 58 (98.3%) on DWI-T2W images. The mean of apparent diffusion coefficient (ADC) values of active fistula was 0.972 ± 0.127 [SD] 10−3 mm2/s and inactive was 1.232 ± 0.185 [SD] 10−3 mm2/s with a significant difference (p-value < 0.0005). A cut-off mean ADC value of 1.105 × 10−3 mm2/s was used to differentiate active from the inactive fistula with a sensitivity of 87.5% and specificity of 73.3%. Conclusion Combined DWI-T2W evaluation had a better performance in the detection of fistula than DWI or T2W alone. DWI with mean ADC calculation had a good performance in differentiating active from the inactive fistulas.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

“…Previously published studies also showed the difference of mean ADC values between the active and inactive fistulas. 3 8 12 14 …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Role of Diffusion-Weighted Imaging in the Evaluation of Perianal Fistulae

Boruah

Hazarika

Ahmed

et al. 2021

Indian Journal of Radiology and Imaging

View full text Add to dashboard Cite

show abstract

Role of MRI special diffusion weighted imaging/diffusion tensor imaging techniques in the assessment of perianal fistula activity

ElSharbatly

Halim

Shaker

et al. 2022

Egypt J Radiol Nucl Med

View full text Add to dashboard Cite

Background Pre-operative MRI examination is currently considered as an evolving tool for assessment of perianal fistula types, extensions, and complications to achieve proper treatment plan. Proper assessment of fistula activity can also have a major contributing role to the treatment plan, through deciding the type of prescribed medications, proper surgical approach as well as the proper operative intervention timing. Reviewing literature, only few studies have mentioned the importance of diffusion tensor imaging (DTI) sequences in diagnosing perianal fistula activity, yet many studies have discussed the perianal fistula activity assessment using other diffusion weighted imaging (DWI) sequences. In the present study, the main objective was to prove the MRI quantitative DTI sequences’ ability of diagnosing perianal fistulae inflammatory activity. Results This study was a prospective analysis in which fistular activity was confirmed by intra-operative findings (considered as the standard reference). The cases included in the study were divided into two groups, based on their surgical findings, positive inflammatory and negative inflammatory groups. Both groups were pre-operatively assessed using MRI imaging and additionally used diffusion weighted and tensor imaging (DWI and DTI) sequences by special post-processing quantitative assessment of DTI FA and ADC values. There was significant statistical difference between the mean ADC value of the PIA and NIA groups in the track, edema, ipsilateral and contralateral sphincter areas with P values (P = 0.000, 0.000, 0.002 and 0.000 respectively). There was also significant difference between the mean FA value of the PIA and NIA groups in the track, edema, ipsilateral and contralateral sphincter areas with P values (P = 0.000, 0.000, 0.000 and 0.008 respectively). Conclusion This study results revealed that FA are relatively lower in positive inflammatory activity lesions than in negative inflammatory activity lesions while the ADC values were relatively higher in positive inflammatory activity lesions than in negative inflammatory activity lesions and the differences were statistically significant having a fundamental role in the assessment of perianal fistula activity especially at the track area being of highest sensitivity and specificity. Unlike conventional MRI sequences which revealed only high specificity being a good negative modality.

show abstract

Magnetic resonance imaging in the workup of patients with perianal fistulas

Madany

Murad

Kabbash

et al. 2023

Egypt J Radiol Nucl Med

View full text Add to dashboard Cite

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

show abstract

Diffusion-weighted imaging in the evaluation of perianal fistula and abscess

Cited by 6 publications

References 20 publications

Role of Diffusion-Weighted Imaging in the Evaluation of Perianal Fistulae

Role of Diffusion-Weighted Imaging in the Evaluation of Perianal Fistulae

Role of MRI special diffusion weighted imaging/diffusion tensor imaging techniques in the assessment of perianal fistula activity

Magnetic resonance imaging in the workup of patients with perianal fistulas

Contact Info

Product

Resources

About