Pankaj Garg1,2, Pratiksha Singh3, Baljit Kaur4. 1. Colorectal Surgery Division, Department of General Surgery, Indus Super Specialty Hospital, Mohali, Punjab, India. drgargpankaj@yahoo.com. 2. Garg Fistula Research Institute, 1042, Sector-15, Panchkula, Haryana, 134113, India. drgargpankaj@yahoo.com. 3. University of North Texas Health Science Center, Fort Worth, TX, USA. 4. Radiology Division, Shamsher Singh Memorial Radio Diagnostic Centre, Chandigarh, India.
Abstract
BACKGROUND: To correlate the operative findings of patients with fistula-in-ano with preoperative MRI and quantify the information added with MRI. METHODS: All consecutive fistula-in-ano patients operated between July 2013 and May 2015 were prospectively enrolled. Preoperative MRI was done in every patient. The details of tracts, internal opening and "complex parameters" (additional tract or additional internal opening, horseshoe tract, associated abscess and supralevator extension) found at surgery were compared to the findings determined by MRI. RESULTS: A total of 229 patients (424 tracts) with mean age-49.0 ± 11.3 years were included. M/F 198/31. James hospital classification: Type I 58, II 20, III 49, IV 86 and V 16. The sensitivity and specificity of MRI in diagnosing fistula tracts were 98.8 and 99.7%, respectively, and in identifying internal opening were 97.7 and 98.6%, respectively. MRI added significant information in 46.7% (107/229) patients which was presence of additional tracts in 71 (66.3%), horseshoe tract in 63 (58.8%), supralevator extension in 16 (14.9%), unsuspected abscess in 11 (10.3%) and multiple internal openings in one patient (1%). The proportion of simple/complex fistula (based on history and clinical examination alone) was 32.8/67.2% which changed to 21.4/78.6% after the MRI scan. MRI added significant information about unsuspecting complex parameters which were missed on history and clinical examination in more than one-third (26/75: 34.6%) of simple fistulae and more than half (81/154: 52.5%) of already known complex fistulae. CONCLUSIONS: MRI is highly accurate in diagnosing fistula-in-ano and added significant information about unsuspected complex parameters in over one-third (34.6%) of simple and in half (52.5%) of complex fistula-in-ano.
BACKGROUND: To correlate the operative findings of patients with fistula-in-ano with preoperative MRI and quantify the information added with MRI. METHODS: All consecutive fistula-in-ano patients operated between July 2013 and May 2015 were prospectively enrolled. Preoperative MRI was done in every patient. The details of tracts, internal opening and "complex parameters" (additional tract or additional internal opening, horseshoe tract, associated abscess and supralevator extension) found at surgery were compared to the findings determined by MRI. RESULTS: A total of 229 patients (424 tracts) with mean age-49.0 ± 11.3 years were included. M/F 198/31. James hospital classification: Type I 58, II 20, III 49, IV 86 and V 16. The sensitivity and specificity of MRI in diagnosing fistula tracts were 98.8 and 99.7%, respectively, and in identifying internal opening were 97.7 and 98.6%, respectively. MRI added significant information in 46.7% (107/229) patients which was presence of additional tracts in 71 (66.3%), horseshoe tract in 63 (58.8%), supralevator extension in 16 (14.9%), unsuspected abscess in 11 (10.3%) and multiple internal openings in one patient (1%). The proportion of simple/complex fistula (based on history and clinical examination alone) was 32.8/67.2% which changed to 21.4/78.6% after the MRI scan. MRI added significant information about unsuspecting complex parameters which were missed on history and clinical examination in more than one-third (26/75: 34.6%) of simple fistulae and more than half (81/154: 52.5%) of already known complex fistulae. CONCLUSIONS: MRI is highly accurate in diagnosing fistula-in-ano and added significant information about unsuspected complex parameters in over one-third (34.6%) of simple and in half (52.5%) of complex fistula-in-ano.
Authors: Gordon Buchanan; Steve Halligan; Andrew Williams; C Richard G Cohen; Danilo Tarroni; Robin K S Phillips; Clive I Bartram Journal: Lancet Date: 2002-11-23 Impact factor: 79.321
Authors: Mark H Whiteford; John Kilkenny; Neil Hyman; W Donald Buie; Jeffrey Cohen; Charles Orsay; Gary Dunn; W Brian Perry; C Neal Ellis; Jan Rakinic; Sharon Gregorcyk; Paul Shellito; Richard Nelson; Joe J Tjandra; Graham Newstead Journal: Dis Colon Rectum Date: 2005-07 Impact factor: 4.585
Authors: A G Maier; M A Funovics; S H Kreuzer; F Herbst; M Wunderlich; B K Teleky; M Mittlböck; W Schima; G L Lechner Journal: J Magn Reson Imaging Date: 2001-09 Impact factor: 4.813
Authors: Gordon N Buchanan; Steve Halligan; Clive I Bartram; Andrew B Williams; Danilo Tarroni; C Richard G Cohen Journal: Radiology Date: 2004-10-21 Impact factor: 11.105
Authors: G N Buchanan; S Halligan; A B Williams; C R G Cohen; D Tarroni; R K S Phillips; C I Bartram Journal: Br J Surg Date: 2003-07 Impact factor: 6.939