Magnetic-resonance tomography in diagnostics of perianal fistulas
Eligulashvili R. R., Zarodnyuk I. Vl., Shelygin Y. A., Kostarev I.V.
| Purpose. To determine the diagnostic value of magnetic resonance imaging in crytogenic peri-anal fistulas. Materials and methods. In the study were included 120 patients with cryptogenic perianal fistulas, the average age was 44.2 ± 3.4 years. All patients underwent magnetic resonance imaging of the pelvic organs with intravenous contrast and diffusion-weighted images. The preoperative MRI data was compared with the intraoperative revision data according to the criteria: the presence of the main fistula tract, the type of fistula, the localization of the inter-nal fistula opening, the presence of additional fistula tract and abscesses of various loca-tions, the involvement of portions of the external sphincter. Results. The sensitivity of MRI in diagnosis of the main fistula tract was 100%; sensi-tivity and specificity in the diagnosis of an additional fistula tract were 95.0% and 97.0%, respectively; sensitivity and specificity in the diagnosis of pararectal abscesses - 87.1% and 90.0%, respectively; sensitivity and specificity in the diagnosis of the internal fistula opening - 94.6% and 33.3%, respectively; sensitivity and specificity in the diagnosis of the external fistula opening were 89.4% and 100%, respectively. The use of intravenous contrast and dif-fusion-weighted images does not increase the diagnostic information of MRI in cryptogenic perianal fistulas. Conclusions. 1. Magnetic resonance imaging is a highly informative diagnostic meth-od for cryptogenic perianal fistulas. 2. Comparative evaluation of different MR scanning se-quences (T2-WI, T2-WI with fat suppression, T1-WI with intravenous contrast, DWI) did not reveal statistically significant differences between them in detecting the main fistulas tract, additional fistula tract, internal and external fistulas opening (p≥0.0125). T2-WI demonstrat-ed higher diagnostic efficacy in assessing the involvement of the external sphincter and in determining the type of fistulas tract, compared to T2-WI with fat suppression, T1-WI with intravenous contrast and DWI (p <0.0125). 3. The main MRI scanning protocol for the study of patients with cryptogenic perianal fistulas includes T2-WI, T2-WI with fat-suppression, DWI. In ambiguous diagnostic situations, after a native MR study, it is possible to add T1-WI with intravenous contrast to the scanning protocol. |
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Keywords: magnetic resonance imaging, perianal fistulas, intravenous contrast, diffu-sion-weighted image.
Corresponding author:: Eligulashvili R.R. e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript
For citation: Eligulashvili R.R., Zarodnyuk I.V., Shelygin Y.A., Kostarev I.V.Magnetic-resonance tomography in diagnostics of perianal fistulas. REJR 2018; 8 (3):213-226. DOI:10.21569/2222-7415-2018-8-3-213-226.
Received:07.08.18Accepted:29.08.18