Yasma Ashraf, Irum Iqbal, Shafaat Khatoon.
Magnetic resonance imaging; the best imaging technique in detection of perianal fistulas with diagnostic accuracy.
Professional Med J Jan ;24(4):560-4.

Perianal fistula is defined as an abnormal communication channel between anal canal and perianal skin. Among all the imaging tools Magnetic resonance imaging (MRI) is of choice in the diagnosis and management of perianal fistulas. Objectives: “To determine the diagnostic accuracy of MR imaging in detection of perianal fistulas and comparing it with per operative findings”. Peroperative findings are taken as gold standard. Place and Duration of Study: This study was carried out in Diagnostic Radiology, Pakistan Institute of Medical Sciences (P.I.M.S) Islamabad, over a period of nine months from 01-02-2012 to 31-10-2012. For this collaboration was made with the Department of General Surgery P.I.M.S and Department of gynecology (MCH center) PIMS and gastroenterology Department. Patients and Methods: A total of 95 patients were included in study having perianal fistulas on clinical examination. MRI was performed in the patients and T1-weighted fast spin echo (T1W FSE) images were taken before and after gadolinium injection. Fat suppressed T2-weighted fast spin echo (T2W FSE) images were obtained in all three planes including transverse, sagittal and coronal. All the scans were viewed by a single consultant radiologist to avoid observer bias. Results: Out of 95, 81 patients (85.3%) were male and 14 (14.7%) were female. Sensitivity, specificity and accuracy of magnetic resonance imaging (MRI) was 96.2%, 75.0% and 92.6%, respectively. Positive predictive value was 95.0% and negative predictive value was 80.0%. Conclusion: our study proves that among imaging modalities MRI is of choice for preoperative assessment of perianal fistulas. It provides highly accurate, noninvasive and relatively very less time consuming means of performing pre-operative evaluation, specially the complex, branching fistulas. This diagnostic accuracy not only helps in surgical cure but avoids recurrence and post-operative complications like fecal incontinence.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com