MR Imaging Evaluation of Perianal fistulae

Abstract

Background: Perianal fistula is a troublesome condition both for patient and surgeon with significant morbidity and challenging treatment. MRI is considered as the technique of choice for preoperative evaluation of perianal fistulae, as it provides accurate anatomical information for appropriate surgical treatment, decreasing the incidence of recurrence and allowing side effects such as fecal incontinence to be avoided. The study aimed to describe the role of magnetic resonance imaging (MRI) in the diagnosis and classification of perianal fistulae.
 Methods: This retrospective study looked at 52 patients referred to the radiology department with a clinical diagnosis of perianal fistula. MRI grading of anal fistula done according to St. James’s University Hospital classification.
 Results: The MRI showed 46 internal openings in 44 patients; two patients had more than one. The internal opening was mostly at the 6 o’clock position in 59.9% patients, followed by 7 o’clock and 5 o’clock position in 11.3% of patients. According to the St. James’s University Hospital classification, 21 (47.7%) patients had grade 1, 11 (25%) patients had grade 2, 2 (4.5%) had grade 3, 7 (15.9%) had grade 4, and 4 (9%) had grade 5 fistulae. Twenty-five patients had associated abscesses. The most common location of the abscess was in the perianal region (8 patients).
 Conclusions: MR imaging examinations is a highly accurate imaging method for preoperative evaluation perianal fistula. It provides precise information of the fistulous track, along with its relationship to pelvic structures and plays crucial role for surgical planning.

MRI Case Report of Perianal Fistula with T2 TSE SPIR Sequence

“…In another study, CT scan fistulography was able to locate the internal orifice in 28 patients (68.2%), whereas MRI was able to detect this aspect in 35 patients (85.3%).was more successful (Shahzad et al, 2021). Granulation tissue, inflammation, and edema around the fistula, abscess, and fistula wall fibrosis were also evaluated, from the study benefit from resonance imaging Magnetic (MR) includes Multiplanar imaging and advanced soft tissue differentiation (Madany et al, 2023;Sharma et al, 2022) MRI is a diagnostic imaging tool that is very crucial in Pelvis MRI in cases of perianal fistula (Chen et al, 2021;Hyde et al, 2018;Lee et al, 2018). Examination technique and Pelvis MRI sequence for perianal fistulas used in routine examinations at MRI Radiology Installation Mayapada Hospital South Jakarta using a marker procedure at a location suspected of having a perianal fistula using vitamin E with the clockwise method and the sequence used T1W_TSE, T2W_TSE, and T2W_TSE_SPIR followed by gadolinium-based contrast material sequence T1W_TSE (Konan et al, 2018;Kakani, 2021;Sarma, 2019;Westbrook & Talbot, 2019).…”