Mri in the Evaluation of Perianal Fistulas

Abstract

Perianal fistulae though uncommon, can be quite distressing to the patient. Correct surgical management requires accurate pre-operative assessment and grading of this condition. MRI is now considered the modality of choice in the pre-operative assessment of perianal fistulae. We did a retrospective analysis of patients who underwent MR imaging for perianal fistulae in our institution, and compared it with the surgical findings. The purpose of the study was to evaluate the accuracy of MRI in the pre-operative grading of perianal fistulae. A total of 32 patients were included in this study. Of these, 12(37%) had type 1 intersphincteric, 8(25%) had type 2 intersphincteric, 6(18%) had type 3 transsphincteric, 4(12%) had type 4 transphincteric, and 2(6%) showed supra-levator extension. MRI was able to correctly grade the fistulous tract in 30 of these 32 patients, giving an accuracy of 94%. MRI was found to be extremely useful in the pre-operative assessment of perianal fistulae. It helps in correctly classifying the fistulae and to detect hidden or deep seated tracts or abscesses which would have been otherwise missed. Thus, it is useful in selecting the most appropriate surgical procedure, thereby reducing the chances of recurrence and to avoid complications such as fecal incontinence from occurring.

MRI Case Report of Perianal Fistula with T2 TSE SPIR Sequence

“…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). Using fat suppression techniques used in MRI examination is Spectral Presaturation with Inversion Recovery (SPIR), a fat suppression method that applies a frequency selective Inversion pulse.…”