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St. Jame's University Hospital MR Imaging Classification of Perianal Fistulas
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Introduction: Fistula–in–ano is an abnormal perianal tract that connects anal canal to the perianal skin. Improper visualization of primary fistulous tract and the associated abscesses or secondary tracts a r e the causes of recurrence. Earlier imaging modalities like conventional fistulography, endosonography and CT scan have had limited role. Eve...
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... our study, St. Jame's University Hospital MR Imaging classification of perianal fistulas identified Grade 4 (Transsphincteric fistula with secondary tract/abscess) in most of the patients 8 (25%), Grade 0 (normal), Grade 1 (simple linear intersphicteric fistulas) and Grade 2 (intersphicteric fistula with secondary tract/abscess) in 4(12.5%) patients and Grade 3 (transsphincteric fistula) and Grade 5 (supralevator and translevator) in 2(6.3%) patients (Table 1). Grade 4 (Trans-sphicteric fistula with abscess or secondary tract within the ischioanal or ischiorectal fossa) ...Citations
... A perianal fistula is an inflammatory condition that causes considerable dilemma in the area around the anal canal [1]. The incidence rate is around two times higher in males than females [2]. Clinically significant symptoms of perianal fistulas include discomfort at the site of the fistula, inflammation, purulent discharge, incontinence, and a low quality of life for the patient [3]. ...
Fat suppression magnetic resonance imaging (MRI) sequences are routinely included in the MRI protocol for patients with perianal fistula to improve the visibility of the abnormal tracts and abscesses against the background of hypo-signal intensity on the image. The objective of this study is to compare the turbo inversion recovery magnitude (TIRM) and frequency selective fat saturation turbo spin echo (FSTSE) MRI sequences in detecting perianal fistulas in terms of time and clarity. The MRI protocol included a coronal T2 turbo inversion recovery magnitude sequence, a T2 fat saturation turbo spin echo, and T2 turbo inversion recovery magnitude sequences in the axial plane. The evaluation of sequence image quality involved calculating the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Additionally three radiologists assessed the best image using a questionnaire designed to align with the study’s objectives. The T2 TIRM sequence was found to have the highest number of ticked images. The inter-rater kappa agreement showed fair agreement (k = 0.370) between the raters. However, the SNR and CNR values for the T2 FSTSE were higher than those of the T2 TIRM sequence, with a p-value less than 0.001. There is a significant difference in the meantime in that the T2 TIRM sequence has less time than the T2 FSTSE with a p-value < 0.001. Due to its uniform fat suppression in the MR image and shorter acquisition time, the turbo inversion recovery magnitude sequence exhibited superior performance compared to the T2 frequency-selective turbo spin echo sequence.
... This is similar to the previous reports with 78% of cases having posteriorly located internal openings [9], [16], [21]. The length of the tract in the current study ranged from 8.7 cm to 1.4 cm, with a mean of 4.72 cm, which corresponds well with the study by [22], which showed a mean length of 3.92.3 cm. ...
Introduction . Perianal fistula rapidly develops an abscess, requiring surgical decompression. However, simple cases must be managed. However, for patients with renal insufficiency, MRI with contrast is contraindicated. It is proposed to use diffusion-weighted images that can diagnose anal fistulae, showing areas of high signal intensity (inflammatory tissues). The aim is to determine sensitivity of diffusion-weighted image combined with T2 turbo inversion recovery magnitude and as an alternative technique to contrast-enhanced MRI using clinical examination as a reference.
Materials and Methods . Study included fifty patients with a clinical diagnosis of perianal fistula. MRI sequences were T2 turbo inversion recovery magnitude in oblique coronal and axial planes, diffusion-weighted image, and T1 weighted image turbo spin echo (fat suppression) pre- and post-administration of contrast agents in oblique axial planes. Three radiologists evaluated the MR imaging data using a questionnaire of parameters that necessitated a binary response, “yes” or “no” answer.
Results. Diffusion-weighted image combined with axial T2 turbo inversion recovery magnitude sequence had 96.7 %. All raters agreed that it is sensitive enough to correctly identify perianal fistula with a moderate Kappa agreement (k = 0.586) and p-value<0.001. The mean value of rater's responses was 76.7 % represents sensitivity of diffusion-weighted images + T2 turbo inversion recovery magnitude as an alternative technique to T1-enhanced contrast with moderate (k = 0.553) agreement between raters and P-value<0.001.
Discussion and Conclusion . Diffusion-weighted images and T2 turbo inversion recovery magnitude sequences exhibit comparable efficacy to T1-enhanced contrast sequences in detecting perianal fistula. This may be an option for patients with renal impairment who cannot receive an MRI contrast.
Nghiên cứu nhằm đánh giá vai trò của cộng hưởng từ (cộng hưởng từ) trong chẩn đoán rò hậu môn (rò hậu môn). Đối tượng gồm 57 bệnh nhân có rò hậu môn được chụp cộng hưởng từ và phẫu thuật (phẫu thuật), 55 nam và 2 nữ (27,5:1), tuổi trung bình 40,2 ± 12,2. Có 57 đường rò chính được tìm thấy trong mổ. Mức độ đồng thuận tốt và rất tốt giữa cộng hưởng từ và phẫu thuật trong phân loại đường rò chính, phát hiện ổ áp xe và đường rò phụ với Kappa lần lượt là 0,607 (0,52;0,695); 0,782 (0,648; 0,916); và 0,82 (0,75;0,89). Độ nhạy và độ đặc hiệu của cộng hưởng từ trong phát hiện lỗ trong là 85% và 66,7%, trong phát hiện áp - xe là 84,6% và 100%. Cả các xung T2W - TSE và T1 TSE - Dixon + Gado đều có độ nhạy và độ đặc hiệu cao trong phát hiện lỗ rò trong, ổ áp xe và đường rò phụ. Như vậy, cộng hưởng từ có độ phân giải mô mềm rất tốt để hiển thị bản đồ giải phẫu quanh hậu môn, đường rò chính và thứ phát với áp xe liên quan đến phức hợp cơ thắt, giúp cho các bác sĩ phẫu thuật đưa ra quyết định trước mổ.
