Clinical Application and Value of MRI on Diagnosis of Complex Anal Fistulas_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Yonggang ¹ , LI Guodong ¹ , YANG Bolin ² , SHAO Wanjin ² , GU Yunfei ²

1.Department of Coloproctology, Guang’anmen Hospital, China Acadmy of Chinese Medicine Sciences, Beijing 100053, China;;
2.Department of Coloproctology, T.C.M. Hospital of Jiangsu Province and Nanjing T.C.M. University Hospital, Nanjing 210029, China;

Corresponding author：

Keywords：

Magnetic resonanace imaging; Complex fistula; Diagnosis; Value

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the value of magnetic resonanace imaging (MRI) on the diagnosis of complex anal fistula. Methods The preoperative digital examination and MRI with the phased-array coil were implemented for 22 patients who were clinically suspected with complex anal fistula. The final diagnosis were based on surgical findings. Outcomes of MRI and digital examination were compared with surgical results.
Results Eighteen patients were diagnosed as complex anal fistula, 1 case of presacral cyst and 3 cases of chronic anorectal fistula combined with perianal mucinous adenocarcinoma. All the patients were correctly diagnosed by MRI, while the patients with presacral cyst and perinaal mucinous adenocarcinoma could not be diagnosed correctly by digital examination. According to the Parks classification, 3 patients suffered from transsphincteric fistula, 11 cases of supra-sphincteric and 5 cases of extra-sphincteric fistula. The diagnosis rates of the internal opening with digital examination and MRI were 33.3% and 72.2%, the rates of the primary tract were 83.3% and 100%, and the rates of the secondary extensions were 16.7% and 88.9%, respectively. The differences in detection of internal opening and secondary extensions between MRI and digital examination were significant (P=0.019, P=0.000), the difference in detection of primary tract was no significant (P=0.072). Conclusion MRI with the phased-array coil can develope the high accuracy in the diagnosis of complex anal fistulas, and reveal the relationship between anorectal sphincters and the complex fistula.

Citation： ZHANG Yonggang ,LI Guodong,YANG Bolin,SHAO Wanjin,GU Yunfei. Clinical Application and Value of MRI on Diagnosis of Complex Anal Fistulas. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(2): 125-128. doi: Copy

1.	Koelbel G, Schmiedl U, Majer MC， et al. Diagnosis of fistulae and sinus tracts in patients with Crohn disease: value of MR imaging [J]. AJR Am J Roentgenol， 1989； 152（5）： 9991003.
2.	de Souza NM, Hall AS, Puni R, et al. High resolution magnetic resonance imaging of the anal sphincter using a dedicated endoanal coil. Comparison of magnetic resonance imaging with surgical findings [J]. Dis Colon　Rectum， 1996； 39(8): 926934.
3.	BeetsTan RG, Morren GL, Beets GL, et al. Measurement of anal sphincter muscles: endoanal US, endoanal MR imaging, or phasedarray MR imaging? A study with healthy volunteers [J]. Radiology, 2001； 220（1）： 8189.
4.	Stoker J, Rociu E, Wiersma TG, et al. Imaging of anorectal disease [J]. Br J Surg， 2000; 87(1): 1027.
5.	Buchanan GN, Halligan S, Bartram CI, et al. Clinical examination, endosonography, and MR imaging in preoperative assessment of fistula in ano: comparison with outcomebased reference standard [J]. Radiology， 2004； 233（3）： 674681.
6.	Parks AG, Gordon PH, Hardcastle JD. A classification of fistulainano [J]. Br J Surg, 1976; 63(1): 112.
7.	王玉成, 谷振春. 常见肛肠疾病 [M]. 哈尔滨：黑龙江朝鲜民族出版社, 1992： 130131.
8.	Marvin L. Corman Colon & Rectal Surgery [M]. 5th Edition. Lippincott Williams & Wilkins, 2004： 222223.
9.	Law PJ, Talbot RW, Bartran CI， et al. Anal endosonography in the evaluation of perianal sepsis and fistula in ano [J]. Br J Surg， 1989; 76（7）: 752755.
10.	Choen S, Burnett S, Bartram CI, et al. Comparison between anal endosonography and digital examination in the evaluation of anal fistulae [J]. Br J Surg， 1991; 78（4）: 445447.
11.	Cammarota T, Discalzo L, Corno F, et al. First experiences with transrectal photomography in perianal abscess pathology [J]. Radiol Med， 1986； 72（11)： 837840.
12.	Cataldo PA, Senagore A, Luchtefeld MA. Intrarectal ultrasound in the evaluation of perirectal abscesses [J]. Dis Colon Rectum, 1993； 36(6): 554558.
13.	Mahjoubi B, Haizadch Kharazi H, Mirzaei R, et al. Diagnostic accuracy of body coil MRI in describing the characteristics of perianal fistulas [J]. Colorectal Dis， 2006； 8（3）： 202207.
14.	Stoker J, Laméris JS. Endoanal magnetic resonance imaging [J]. Acta Gastroenterol Belg, 1997； 60(4): 274277.
15.	Halligan S, Bartram CI. MR imaging of fistula in ano: are endoanal coils the gold standard? [J]. AJR Am J Roentgenol， 1998； 171（2）: 407412.

1. Koelbel G, Schmiedl U, Majer MC， et al. Diagnosis of fistulae and sinus tracts in patients with Crohn disease: value of MR imaging [J]. AJR Am J Roentgenol， 1989； 152（5）： 9991003.
2. de Souza NM, Hall AS, Puni R, et al. High resolution magnetic resonance imaging of the anal sphincter using a dedicated endoanal coil. Comparison of magnetic resonance imaging with surgical findings [J]. Dis Colon　Rectum， 1996； 39(8): 926934.
3. BeetsTan RG, Morren GL, Beets GL, et al. Measurement of anal sphincter muscles: endoanal US, endoanal MR imaging, or phasedarray MR imaging? A study with healthy volunteers [J]. Radiology, 2001； 220（1）： 8189.
4. Stoker J, Rociu E, Wiersma TG, et al. Imaging of anorectal disease [J]. Br J Surg， 2000; 87(1): 1027.
5. Buchanan GN, Halligan S, Bartram CI, et al. Clinical examination, endosonography, and MR imaging in preoperative assessment of fistula in ano: comparison with outcomebased reference standard [J]. Radiology， 2004； 233（3）： 674681.
6. Parks AG, Gordon PH, Hardcastle JD. A classification of fistulainano [J]. Br J Surg, 1976; 63(1): 112.
7. 王玉成, 谷振春. 常见肛肠疾病 [M]. 哈尔滨：黑龙江朝鲜民族出版社, 1992： 130131.
8. Marvin L. Corman Colon & Rectal Surgery [M]. 5th Edition. Lippincott Williams & Wilkins, 2004： 222223.
9. Law PJ, Talbot RW, Bartran CI， et al. Anal endosonography in the evaluation of perianal sepsis and fistula in ano [J]. Br J Surg， 1989; 76（7）: 752755.
10. Choen S, Burnett S, Bartram CI, et al. Comparison between anal endosonography and digital examination in the evaluation of anal fistulae [J]. Br J Surg， 1991; 78（4）: 445447.
11. Cammarota T, Discalzo L, Corno F, et al. First experiences with transrectal photomography in perianal abscess pathology [J]. Radiol Med， 1986； 72（11)： 837840.
12. Cataldo PA, Senagore A, Luchtefeld MA. Intrarectal ultrasound in the evaluation of perirectal abscesses [J]. Dis Colon Rectum, 1993； 36(6): 554558.
13. Mahjoubi B, Haizadch Kharazi H, Mirzaei R, et al. Diagnostic accuracy of body coil MRI in describing the characteristics of perianal fistulas [J]. Colorectal Dis， 2006； 8（3）： 202207.
14. Stoker J, Laméris JS. Endoanal magnetic resonance imaging [J]. Acta Gastroenterol Belg, 1997； 60(4): 274277.
15. Halligan S, Bartram CI. MR imaging of fistula in ano: are endoanal coils the gold standard? [J]. AJR Am J Roentgenol， 1998； 171（2）: 407412.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Application and Value of MRI on Diagnosis of Complex Anal Fistulas

Abstract Full text Figures/Tables Video References Cited by

Format

Content