Journal of Surgery

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Role of MRI Fistulography with Gadopentate Enhancement in Assessment of Complex Anal Fistulas and Improving Surgical Outcomes

Received: 11 March 2017    Accepted: 20 March 2017    Published: 10 April 2017
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Abstract

Preoperative assessment of complex fistula-in-ano (FIA) is crucial for decision making. Magnetic resonance imaging (MRI) has been used for assessment of perianal sepsis with various protocols and methods. The aim of the present study was to assess the concordance between MRI fistulography with gadopentate enhancement and the intraoperative surgical findings, and to study the impact of preoperative assessment with MRI on surgical outcomes including fistula recurrence and fecal incontinence (FI). Patients with complex and high FIA who were investigated by MRI fistulography preoperatively were reviewed. The concordance between the findings of MRI and the intraoperative findings on examination under anesthesia (EUA) was made using Kappa coefficient test. The accuracy and sensitivity of MRI were calculated regrading detection of the internal opening, primary and secondary fistula tracts. 95 patients (82% males) were included in the study. MRI fistulography had an accuracy of 89.4%, 96.8%, 96.8%, 98%, and 98% in detection of the internal opening, number of tracts, position of primary tract, secondary extensions, and presence of abscess cavities, respectively. Overall, there was very good concordance between MRI and EUA regarding the examined parameters (k= 0.847, 0.937, 0.908, 0.953, 0.957), respectively. Fistula recurrence and minor FI were recorded in 4.2% and 14.7% of patients. MRI fistulography is an effective diagnostic modality for the preoperative assessment of FIA. MRI had excellent accuracy and sensitivity in detection of the internal opening, primary tract, and secondary extensions of anal fistula with very good concordance with the intraoperative findings.

DOI 10.11648/j.js.20170502.13
Published in Journal of Surgery (Volume 5, Issue 2, April 2017)
Page(s) 22-27
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

MRI, Fistulography, Anal Fistula, Complex, Assessment, Outcomes

References
[1] Saino, P. “Fistula-in-ano in a defined population: incidence and epidemiological aspects.” Ann. Chir. Gynaecol. 1984; 73: 219–224.
[2] Buchanan G, Halligan S, Williams A, et al. Effect of MRI on clinical outcome of recurrent fistula-in-ano. Lancet 2002; 360: 1661–1662.
[3] 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.
[4] D’Hoore A, Penninckx F. The pathology of complex fistula in ano. Acta Chir Belg 2000; 100: 111–114.
[5] Maier AG, Funovics MA, Kreuzer SH, et al. Evaluation of perianal sepsis: comparison of anal endosonography and magnetic resonance imaging. J Magn Reson Imaging 2001; 14: 254–260.
[6] Schwartz DA, Wiersema MJ, Dudiak KM, 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.
[7] Morris J, Spencer JA, Ambrose NS. MR imaging classification of perianal fistulas and its implications for patient management. Radiographics 2000; 20 (3): 623–635.
[8] Ziech M, Felt-Bersma R, Stoker J. Imaging of perianal fistulas. Clin Gastroenterol Hepatol 2009; 7 (10): 1037–1045.
[9] Horsthuis K, Lavini C, Bipat S, Stokkers PC, Stoker J. Perianal Crohn disease: evaluation of dynamic contrast-enhanced MR imaging as an indicator of disease activity. Radiology 2009; 251 (2): 380–387.
[10] Spencer JA, Ward J, Ambrose NS. Dynamic contrast enhanced MR imaging of perianal fistulae. Clin Radiol 1998; 53: 96–104.
[11] deSouza NM, Kmiot WA, Puni R et al. High resolution magnetic resonance imaging of the anal sphincter using an internal coil. Gut 1995; 37: 284–287.
[12] Kołodziejczak M, Santoro GA, Obcowska A, Lorenc Z, Mańczak M, Sudoł-Szopińska I. Three-dimensional endoanal ultrasound is accurate and reproducible in determining type and height of anal fistulae. Colorectal Dis. 2016; doi: 10.1111/codi.13580.
[13] Siddiqui MR, Ashrafian H, Tozer P, Daulatzai N, Burling D, Hart A. A diagnostic accuracy meta-analysis of endoanal ultrasound and MRI for perianal fistula assessment. Dis Colon Rectum. 2012; 55 (5): 576-85. doi: 10.1097/DCR.0b013e318249d26c.
[14] Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993; 36: 77–97.
[15] Morris J, Spencer JA, Ambrose NS. MR Imaging Classification of Perianal Fistulas and Its Implications for Patient Management. Radiographics. 2000 May-Jun; 20 (3): 623-35; discussion 635-7.
[16] Emile SH, Elfeki H, Thabet W, Sakr A, Magdy A, Abd El-Hamed T, Omar W, Khafagy W. P redictive Factors for Recurrence of High Trans-sphincteric Anal Fistula after Placement of Seton. J Surg Res. 2017. DOI: http://dx.doi.org/10.1016/j.jss.2017.02.053 [Epub Ahead of Print].
[17] Ratto C, Grillo E, Parello A, Costamagna G, Doglietto GB. Endoanal ultrasound-guided surgery for anal fistula. Endoscopy. 2005; 37 (8): 722–8. doi: 10.1055/s-2005-870155.
[18] Lunniss PJ, Armstrong P, Barker PG, Reznek RH, Phillips RK. Magnetic resonance imaging of anal fistulae. Lancet. 1992; 340: 394–396. doi: 10.1016/0140-6736(92)91472-K.
[19] Torkzad MR, Karlbom U. MRI for assessment of anal fistula. Insights into Imaging. 2010; 1 (2): 62-71. doi: 10.1007/s13244-010-0022-y.
[20] West RL, Zimmerman DD, Dwarkasing S, Hussain SM, Hop WC, Schouten WR, Kuipers EJ, Felt-Bersma RJ. Prospective comparison of hydrogen peroxide-enhanced three-dimensional endoanal ultrasonography and endoanal magnetic resonance imaging of perianal fistulas. Dis Colon Rectum. 2003; 46 (10): 1407–1415. doi: 10.1007/s10350-004-6758-z.
[21] Maier AG, Funovics MA, Kreuzer SH, Herbst F, Wunderlich M, Teleky BK, Mittlböck M, Schima W, Lechner GL. Evaluation of perianal sepsis: comparison of anal endosonography and magnetic resonance imaging. J Magn Reson Imaging. 2001; 14 (3): 254–260. doi: 10.1002/jmri.1181.
[22] O’Malley RB, Al-Hawary MM, Kaza RK, et al. Rectal Imaging: Part 2, Perianal Fistula Evaluation on Pelvic MRI – What the Radiologist Needs to Know. Am J Roentgenol. 2012; 199 (1): 43–53.
[23] Horsthuis K, Lavini C, Bipat S, Stokkers PC, Stoker J. Perianal Crohn disease: evaluation of dynamic contrast-enhanced MR imaging as an indicator of disease activity. Radiology. 2009; 251 (2): 380–387. doi: 10.1148/radiol.2512072128.
[24] Spencer JA, Chapple K, Wilson D, Ward J, Windsor ACJ, Ambrose NS. Outcome after surgery for perianal fistula: predictive value of MR imaging. AJR Am J Roentgenol 1998; 171: 403-406.
[25] Mahjoubi B, Kharazi HH, Mirzari R, et al. Diagnostic accuracy of body coil MRI in describing the characteristics of perianal fistulas. Colorectal Dis. 2005; 8 (2): 202–7.
[26] Lo Re G, Tudisca C, Vernuccio F, Picone D, Cappello M, Agnello F, Galia M, Galfano MC, Biscaldi E, Salerno S, Pinto A, Midiri M, Lagalla R. MR imaging of perianal fistulas in Crohn's disease: sensitivity and specificity of STIR sequences. Radiol Med. 2016 Apr; 121 (4): 243-51. doi: 10.1007/s11547-015-0603-4.
[27] Waniczek D, Adamczyk T, Arendt J, Kluczewska E. Direct MRI fistulography with hydrogen peroxide in patients with recurrent perianal fistulas: a new proposal of extended diagnostics. Med Sci Monit. 2015 Feb 10; 21: 439-45. doi: 10.12659/MSM.891232.
[28] Beets-Tan RG, Beets GL, van der Hoop AG, et al. Preoperative MRI of anal fistulas: Does it really help the surgeon? Radiology. 2001; 218: 75–84.
Author Information
  • Colorectal Surgery Unit, General Surgery Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura City, Egypt

  • Colorectal Surgery Unit, General Surgery Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura City, Egypt

  • Colorectal Surgery Unit, General Surgery Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura City, Egypt

  • Colorectal Surgery Unit, General Surgery Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura City, Egypt

  • Colorectal Surgery Unit, General Surgery Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura City, Egypt

  • Colorectal Surgery Unit, General Surgery Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura City, Egypt

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  • APA Style

    Mahmoud Abdelnaby, Sameh Hany Emile, Ahmad Sakr, Alaa Magdy, ElYamani Fouda, et al. (2017). Role of MRI Fistulography with Gadopentate Enhancement in Assessment of Complex Anal Fistulas and Improving Surgical Outcomes. Journal of Surgery, 5(2), 22-27. https://doi.org/10.11648/j.js.20170502.13

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    ACS Style

    Mahmoud Abdelnaby; Sameh Hany Emile; Ahmad Sakr; Alaa Magdy; ElYamani Fouda, et al. Role of MRI Fistulography with Gadopentate Enhancement in Assessment of Complex Anal Fistulas and Improving Surgical Outcomes. J. Surg. 2017, 5(2), 22-27. doi: 10.11648/j.js.20170502.13

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    AMA Style

    Mahmoud Abdelnaby, Sameh Hany Emile, Ahmad Sakr, Alaa Magdy, ElYamani Fouda, et al. Role of MRI Fistulography with Gadopentate Enhancement in Assessment of Complex Anal Fistulas and Improving Surgical Outcomes. J Surg. 2017;5(2):22-27. doi: 10.11648/j.js.20170502.13

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  • @article{10.11648/j.js.20170502.13,
      author = {Mahmoud Abdelnaby and Sameh Hany Emile and Ahmad Sakr and Alaa Magdy and ElYamani Fouda and Ahmed Abdel Mawla},
      title = {Role of MRI Fistulography with Gadopentate Enhancement in Assessment of Complex Anal Fistulas and Improving Surgical Outcomes},
      journal = {Journal of Surgery},
      volume = {5},
      number = {2},
      pages = {22-27},
      doi = {10.11648/j.js.20170502.13},
      url = {https://doi.org/10.11648/j.js.20170502.13},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.js.20170502.13},
      abstract = {Preoperative assessment of complex fistula-in-ano (FIA) is crucial for decision making. Magnetic resonance imaging (MRI) has been used for assessment of perianal sepsis with various protocols and methods. The aim of the present study was to assess the concordance between MRI fistulography with gadopentate enhancement and the intraoperative surgical findings, and to study the impact of preoperative assessment with MRI on surgical outcomes including fistula recurrence and fecal incontinence (FI). Patients with complex and high FIA who were investigated by MRI fistulography preoperatively were reviewed. The concordance between the findings of MRI and the intraoperative findings on examination under anesthesia (EUA) was made using Kappa coefficient test. The accuracy and sensitivity of MRI were calculated regrading detection of the internal opening, primary and secondary fistula tracts. 95 patients (82% males) were included in the study. MRI fistulography had an accuracy of 89.4%, 96.8%, 96.8%, 98%, and 98% in detection of the internal opening, number of tracts, position of primary tract, secondary extensions, and presence of abscess cavities, respectively. Overall, there was very good concordance between MRI and EUA regarding the examined parameters (k= 0.847, 0.937, 0.908, 0.953, 0.957), respectively. Fistula recurrence and minor FI were recorded in 4.2% and 14.7% of patients. MRI fistulography is an effective diagnostic modality for the preoperative assessment of FIA. MRI had excellent accuracy and sensitivity in detection of the internal opening, primary tract, and secondary extensions of anal fistula with very good concordance with the intraoperative findings.},
     year = {2017}
    }
    

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  • TY  - JOUR
    T1  - Role of MRI Fistulography with Gadopentate Enhancement in Assessment of Complex Anal Fistulas and Improving Surgical Outcomes
    AU  - Mahmoud Abdelnaby
    AU  - Sameh Hany Emile
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    PB  - Science Publishing Group
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    UR  - https://doi.org/10.11648/j.js.20170502.13
    AB  - Preoperative assessment of complex fistula-in-ano (FIA) is crucial for decision making. Magnetic resonance imaging (MRI) has been used for assessment of perianal sepsis with various protocols and methods. The aim of the present study was to assess the concordance between MRI fistulography with gadopentate enhancement and the intraoperative surgical findings, and to study the impact of preoperative assessment with MRI on surgical outcomes including fistula recurrence and fecal incontinence (FI). Patients with complex and high FIA who were investigated by MRI fistulography preoperatively were reviewed. The concordance between the findings of MRI and the intraoperative findings on examination under anesthesia (EUA) was made using Kappa coefficient test. The accuracy and sensitivity of MRI were calculated regrading detection of the internal opening, primary and secondary fistula tracts. 95 patients (82% males) were included in the study. MRI fistulography had an accuracy of 89.4%, 96.8%, 96.8%, 98%, and 98% in detection of the internal opening, number of tracts, position of primary tract, secondary extensions, and presence of abscess cavities, respectively. Overall, there was very good concordance between MRI and EUA regarding the examined parameters (k= 0.847, 0.937, 0.908, 0.953, 0.957), respectively. Fistula recurrence and minor FI were recorded in 4.2% and 14.7% of patients. MRI fistulography is an effective diagnostic modality for the preoperative assessment of FIA. MRI had excellent accuracy and sensitivity in detection of the internal opening, primary tract, and secondary extensions of anal fistula with very good concordance with the intraoperative findings.
    VL  - 5
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