Contribution of preoperative magnetic resonance imaging in diagnosis and surgical treatment of anal fistula

Year 2020, Volume: 45 Issue: 3, 1210 - 1216, 30.09.2020

Mehmet Bayrak Yasemin Altıntaş Ömer Alabaz Medih Çeliktaş

https://doi.org/10.17826/cumj.780148

Cited By: 2

Abstract

Purpose: This study aims to investigate the accuracy of MR imaging in patients with anal fistula and the information quantitatively added by MR imaging and to identify the group of patients where MR imaging is more likely to provide complementary information.
Materials and Methods: The present cohort was a retrospective work of consecutive patients diagnosed with primary anal fistula who underwent surgery and preoperative MR imaging between 15 January 2018 and 15 June 2020. Any complementary radiological information was derived from preoperative MR imaging reports. The inconsistencies were noted between surgical findings and MR imaging records.
Results: The study consisted of 160 patients with 179 tracts, 92 men and 68 women. The mean patient age was 44.6±10.1 (18-65) years. In total, 97 patients suffered from recurrent fistulas (60.6%). The specificity and sensitivity of MR imaging in detecting fistula tracts were 93.5 and 98.9 % %, respectively. The diagnostic accuracy of MR imaging in identifying the fıstula tract and internal opening was 97.8 % and 97.5%, respectively. The contribution of preoperative MR imaging was statistically more significant if the external opening was over 3 cm from the anal canal (10.9% vs. 47.8%,) and when a horseshoe fistula was present (39.6% vs. 63.8%).
Conclusion: We found that MR imaging had high specificity, sensitivity, and diagnostic accuracy in discovering both fistula tracts and the internal opening, we consider that MR imaging should be used routinely in almost all simple and complex fistulas.

Keywords

anal fistula, magnetic resonance imaging, surgical treatment

Preoperatif manyetik rezonans görüntülemenin anal fistül tanı ve cerrahi tedavisine katkısı

Abstract

Amaç: Bu çalışma, anal fistülü olan hastalarda MR görüntülemenin doğruluğunu ve MR görüntülemeyle kantitatif olarak eklenen bilgileri araştırmayı ve MR görüntülemenin tamamlayıcı bilgi sağlama olasılığının daha yüksek olduğu hasta grubunu belirlemeyi amaçlamaktadır.
Gereç ve Yöntem: Bu çalışma 15 Ocak 2018-15 Haziran 2020 tarihleri arasında primer anal fistül tanısı alan, cerrahi ve preoperatif MR görüntüleme yapılan hastalar retrospektif olarak değerlendirildi. Preoperatif olarak çekilen manyetik resonance görüntüleri incelenerek tedavi ve teşhise katkı sağlayan ek bilgiler elde edildi. Cerrahi bulgular ile manyetik rezonans görüntüleme bulguları arasındaki tutarsızlıklar kaydedildi.
Bulgular: Çalışmamız 92 erkek ve 68 kadın olmak üzere 179 trakttı olan 160 hastayı içermekte idi. Yaş ortalaması 44,6 ± 10,1 (18-65) yıl idi. Toplamda 97 (%60,6) hastada nüks fistül mevcuttu. MR görüntülemenin fistula traktlarının saptanmasında özgüllüğü ve duyarlılığı sırasıyla %93,5 ve %98,9 idi. MR görüntülemenin fistula traktını ve iç açıklığı saptamadaki tanısal doğruluğu sırasıyla %97,8 ve %97,5 idi. Ameliyat öncesi MR görüntülemenin katkısı, dış açıklık anal kanaldan 3 cm'in üzerinde ise ve at nalı fistülü bulunduğunda istatistiksel olarak daha anlamlıydı.
Sonuç: Manyetik rezonans görüntüleme hem fistula traktlarını hem de iç açıklığı tespit etmede yüksek özgüllüğe, duyarlılığa ve tanısal doğruluğa sahip olduğunu saptadık. Manyetik rezonans görüntülemenin tüm basit ve kompleks fistüllerde rutin olarak kullanılması gerektiğini öneriyoruz.

Keywords

Anal fistül, manyetik rezonans görüntüleme, cerrahi tedavi

References

• REFERENCES 1. Krieglstein CF. Surgical procedures for perianal sepsis: ıschiorectal abscesses, fistulas, and pilonidal sinus. In: Thomas WEG, Senninger N (eds). Short Stay Surgery. Springer, Berlin, 2008;15: 295–308.
• 2. Halligan S, Stoker J. Imaging of fistula in ano. Radiology. 2006; 239:18–33.
• 3. Parks AG, Gordon PH, Hardcastle JD. A classification of fistula-in-ano. Br J Surg. 1976;63:1–12.
• 4. Whiteford MH, Kilkenny J 3rd, Hyman N, Buie WD, Cohen J, Orsay C, et al. Standards Practice Task Force; American Society of Colon and Rectal Surgeons. Practice parameters for the treatment of perianal abscess and fistula-in-ano (revised). Dis Colon Rectum. 2005; 48:1337-1342.
• 5. Morris J, Spencer JA, Ambrose NS. MR imaging classification of perianal fistulas and its implications for patient management. Radiographics 2000;20:623–635.
• 6. Goodsall DH, Miles WE. Diseases of the anus and rectum. London: Longmans, Green; 1900; 92–173.
• 7. Kuijpers HC, Schulpen T. Fistulography for fistula-in-ano. Is it useful? Dis Colon Rectum. 1985; 28:103–104.
• 8. Liang C, Lu Y, Zhao B, Du Y, Wang C, Jiang W. Imaging of anal fistulas: comparison of computed tomographic fistulography and magnetic resonance imaging. Korean J Radiol. 2014;15:712-723.
• 9. Siddiqui MR, Ashrafian H, Tozer P, Daulatzai N, Burling D, Hart A, et al. A diagnostic accuracy meta-analysis of endoanal ultrasound and MRI for perianal fistula assessment. Dis Colon Rectum. 2012 ;55:576-585.
• 10. Williams JG, Farrands PA, Williams AB, Taylor BA, Lunniss PJ, Sagar PM, Varma JS, et al. The treatment of anal fistula: ACPGBI position statement. Colorectal Dis. 2007 ;9 4:18-50.
• 11. Thipphavong S, Costa AF, Ali HA, Wang DC, Brar MS, Jhaveri KS. Structured reporting of MRI for perianal fistula. Abdom Radiol (NY). 2019;44:1295-1305.
• 12. Garg P, Singh P, Kaur B. Magnetic Resonance Imaging (MRI): Operative Findings Correlation in 229 Fistula-in-Ano Patients. World J Surg. 2017;41:1618-1624.
• 13. Buchanan GN, Halligan S, Bartram CI, Williams AB, Tarroni D, Cohen CR. Clinical examination, endosonography, and MR imaging in preoperative assessment of fistula in ano: comparison with outcome-based reference standard. Radiology. 2004 ;233:674-681
• 14. Buchanan GN, Halligan S, Williams AB, Cohen CR, Tarroni D, Phillips RK, et al. Magnetic resonance imaging for primary fistula in ano. Br J Surg. 2003;90:877-881.
• 15. Buchanan G, Halligan S, Williams A, Cohen CR, Tarroni D, Phillips RK, et al. Effect of MRI on clinical outcome of recurrent fistula-in-ano. Lancet. 2002 Nov 23;360(9346):1661-1662. 16. Beckingham IJ, Spencer JA, Ward J, Dyke GW, Adams C, Ambrose NS. Prospective evaluation of dynamic contrast enhanced magnetic resonance imaging in the evaluation of fistula in ano. Br J Surg. 1996;83:1396-1398.
• 17. Mullen R, Deveraj S, Suttie SA, Matthews AG, Yalamarthi S. MR imaging of fistula in ano: indications and contribution to surgical assessment. Acta Chir Belg. 2011 ;111:393-397.
• 18. Schwartz DA, Wiersema MJ, Dudiak KM, Fletcher JG, Clain JE, Tremaine WJ, et al. A comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluation of Crohn's perianal fistulas. Gastroenterology. 2001;121:1064-1072.
• 19. Orsoni P, Barthet M, Portier F, Panuel M, Desjeux A, Grimaud JC. Prospective comparison of endosonography, magnetic resonance imaging and surgical findings in anorectal fistula and abscess complicating Crohn's disease. Br J Surg. 1999;86:360-364.
• 20. Hussain SM, Stoker J, Schouten WR, Hop WC, Laméris JS. Fistula in ano: endoanal sonography versus endoanal MR imaging in classification. Radiology. 1996;200:475-481.
• 21. Maier AG, Funovics MA, Kreuzer SH, Herbst F, Wunderlich M, Teleky BK, et al. Evaluation of perianal sepsis: comparison of anal endosonography and magnetic resonance imaging. J Magn Reson Imaging. 2001;14:254-260.
• 22. Practice parameters for treatment of fistula-in-ano. The Standards Practice Task Force. The American Society of Colon and Rectal Surgeons. Dis Colon Rectum. 1996 ;39:1361-1362.
• 23. Beets-Tan RG, Beets GL, van der Hoop AG, et al. Preoperative MR imaging of anal fistulas: Does it really help the surgeon? Radiology 2001; 218:75-84.
• 24. Chapple KS, Spencer JA, Windsor AC, Wilson D, Ward J, Ambrose NS. Prognostic value of magnetic resonance imaging in the management of fistula-in-ano. Dis Colon Rectum. 2000;43:511-516.
• 25. Spencer JA, Chapple K, Wilson D, Ward J, Windsor AC, Ambrose NS. Outcome after surgery for perianal fistula: predictive value of MR imaging. AJR Am J Roentgenol. 1998; 171:403–406.
• 26. Konan A, Onur MR, Özmen MN. The contribution of preoperative MRI to the surgical management of anal fistulas. Diagn Interv Radiol. 2018 ;24:321-327.
• 27. Myhr GE, Myrvold HE, Nilsen G, Thoresen JE, Rinck PA. Perianal fistulas: use of MR imaging for diagnosis. Radiology. 1994; 191:545–549.
• 28. Chauhan NS, Sood D, Shukla A. Magnetic resonance imaging (MRI) characterization of perianal fistulous disease in a rural based tertiary hospital of North India. Pol J Radiol. 2016, 81:611–617.