The development of a minimum dataset for MRI reporting of anorectal fistula: a multi-disciplinary, expert consensus process

Abstract

There are a range of sphincter-preserving procedures available to treat anorectal fistula, some of which can be precluded, or rendered more optimal by specific features of fistula anatomy. Magnetic resonance imaging (MRI) is the gold standard modality for assessing anorectal fistula. To maximise clinical utility, the MRI report should accurately describe these clinically relevant features. We aimed to develop a minimum dataset for reporting MRI of anorectal fistula, in order to improve the assessment and management of these patients. A longlist of 70 potential items for the minimum dataset was generated through systematic review of the literature. This longlist was presented to radiologists, surgeons and gastroenterologists in an online survey to understand the features that shape current clinical practice. The longlist and survey results were then presented to an expert consensus panel to generate the final minimum dataset through discussion and anonymous voting. The final minimum dataset details the general characteristics, features of the internal and external openings, path of the fistula through the sphincters and any associated extensions and collections that should be described in all MRI reports for anal fistula. Additional surgical and perianal Crohn’s disease subsets were developed to indicate the features that aid decision-making for these patients, in addition to a minimum dataset for the clinical request. This study represents a multi-disciplinary approach to developing a minimum dataset for MRI reporting of anal fistula, highlighting the most important features to report that can assist in clinical decision-making. Key Points • This paper recommends the minimum features that should be included in all MRI reports for the assessment of anal fistula, including Parks classification, number of tracts, features of the internal and external opening, path of the tract through the sphincters, the presence and features of extensions and collections. • Additional features that aid decision-making for surgery or in the presence of Crohn’s disease have been identified. • The items that should be included when requesting an MRI are specified.

Perianal Fistula: An Overview

“…이 중 결과로 최소한의 MRI 보고 체계에 대한 내용은 Table 3 에 정리되어 있다. 또한, 2022년 영국 그룹에서 Iqbal 등( 31 )이 발표한 다학제 연구에서 항문주위 샛길에 대한 MR 보고체계에 대한 최소한의 데이터세트를 발표하였다( Table 4 ) ( 31 ). 위의 연구 결과에서 공통적으로 제안하는 소견 중, 1차 샛길의 타입, 내부 및 외부 샛길 구멍의 위치를 시계방향에 따라 기술하는 것, 동반된 농양의 여부, 항문조임근의 정상 유지 여부 등에 대해서는 기술하는 것이 중요하다.…”