Abstract
Purpose
To evaluate the diagnostic efficacy between pre- and post-contrast MRI sequences in perianal fistulas using intra-operative findings as the gold standard.
Materials and methods
Retrospective analysis of 50 patients with a history of perianal fistula and MRI performed between January 2006 and January 2018 was performed. The inclusion criteria were patients who underwent MRI prior to surgery and had a detailed surgical report available. Pre- and post-contrast MR data sets were evaluated by two radiologists at two-week-intervals, assessed fistula type, internal/external opening, presence of abscess/secondary tracts, and confidence scores. The area under the curve (AUC) was used for comparison the diagnostic ability. The sensitivity and specificity were compared using the McNemar’s test.
Results
The confidence scores in detecting perianal fistulas were significantly higher in the post-contrast MR data set (p < 0.003). The post-contrast MR data set had similar ability to classify perianal fistulas as combined T2-DWI and isolated T2 data sets in 49/50 cases. For internal/external opening, the post-contrast MR, combined T2-DWI, and isolated T2 data sets had 100% concordance with intra-operative reports. For perianal abscess, there was no significant difference in sensitivity or AUC value between the isolated T2 or combined T2-DWI data sets and post-contrast MR data set (p > 0.05). All MR data sets correctly identified secondary tracts in all 50 cases.
Conclusions
Although contrast-enhanced MR studies can improve a radiologist’s confidence, non-contrast MR studies had similar diagnostic efficacy in identifying perianal fistulas and their complications. Therefore, a non-contrast study may suffice in selected patients such as those with renal impairment.
Similar content being viewed by others
References
Vanbeckevoort D, Bielen D, Vanslembrouck R, Van Assche G (2014) Magnetic resonance imaging of perianal fistulas. Magn Reson Imaging Clin N Am 22:113–123. https://doi.org/10.1016/j.mric.2013.07.008
Zanotti C, Martinez-Puente C, Pascual I, et al. (2007) An assessment of the incidence of fistula-in-ano in four countries of the European Union. Int J Colorectal Dis 22:1459–1462. https://doi.org/10.1007/s00384-007-0334-7
Sainio P (1984) Fistula-in-ano in a defined population. Incidence and epidemiological aspects. Ann Chir Gynaecol 73:219–224
Parks AG, Gordon PH, Hardcastle JD (1976) A classification of fistula-in-ano. Br J Surg 63:1–12. https://doi.org/10.1002/bjs.1800630102
de Miguel Criado J, del Salto LG, Rivas PF, et al. (2012) MR imaging evaluation of perianal fistulas: spectrum of imaging features. RadioGraphics 32:175–194. https://doi.org/10.1148/rg.321115040
Morris J, Spencer JA, Ambrose NS (2000) MR imaging classification of perianal fistulas and its implications for patient management. RadioGraph 20:623–635. https://doi.org/10.1148/radiographics.20.3.g00mc15623
Sandborn WJ, Fazio VW, Feagan BG, Hanauer SB (2003) AGA technical review on perianal Crohn’s disease. Gastroenterology 125:1508–1530. https://doi.org/10.1016/j.gastro.2003.08.025
Hamadani A, Haigh PI, Liu I-LA, Abbas MA (2009) Who is at risk for develo** chronic anal fistula or recurrent anal sepsis after initial perianal abscess? Dis Colon Rectum 52:217–221. https://doi.org/10.1007/DCR.0b013e31819a5c52
Jordán J, Roig JV, García-Armengol J, et al. (2010) Risk factors for recurrence and incontinence after anal fistula surgery. Colorectal Dis 12:254–260. https://doi.org/10.1111/j.1463-1318.2009.01806.x
Gallego JC, Echarri A (2017) Role of magnetic resonance imaging in the management of perianal Crohn’s disease. Insights Imaging 9:1–12. https://doi.org/10.1007/s13244-017-0579-9
Kordbacheh H, Baliyan V, Serrao J, et al. (2017) Imaging in patients with Crohn’s disease: trends in abdominal CT/MRI utilization and radiation exposure considerations over a 10-year period. Inflamm Bowel Dis 23:1025–1033. https://doi.org/10.1097/MIB.0000000000001088
Spencer JA, Ward J, Beckingham IJ, Adams C, Ambrose NS (1996) Dynamic contrast-enhanced MR imaging of perianal fistulas. Am J Roentgenol 167:735–741. https://doi.org/10.2214/ajr.167.3.8751692
Shellock FG, Spinazzi A (2008) MRI safety update 2008: part 1, MRI contrast agents and nephrogenic systemic fibrosis. Am J Roentgenol 191:1129–1139. https://doi.org/10.2214/AJR.08.1038.1
Gulani V, Calamante F, Shellock FG, Kanal E, Reeder SB (2017) Gadolinium deposition in the brain: summary of evidence and recommendations. Lancet Neurol 16:564–570. https://doi.org/10.1016/S1474-4422(17)30158-8
Kanda T, Ishii K, Kawaguchi H, Kitajima K, Takenaka D (2013) High signal intensity in the dentate nucleus and globus pallidus on unenhanced T1-weighted MR images: relationship with increasing cumulative dose of a gadolinium-based contrast material. Radiology 270:834–841. https://doi.org/10.1148/radiol.13131669
Garcia-Reyes K, Passoni NM, Palmeri ML, et al. (2015) Detection of prostate cancer with multiparametric MRI (mpMRI): effect of dedicated reader education on accuracy and confidence of index and anterior cancer diagnosis. Abdom Imaging 40:134–142. https://doi.org/10.1007/s00261-014-0197-7
Van Assche G, Vanbeckevoort D, Bielen D, et al. (2003) Magnetic resonance imaging of the effects of infliximab on perianal fistulizing Crohn’s disease. Am J Gastroenterol 98:332–339
Beets-Tan RGH, Beets GL, van der Hoop AG, et al. (2001) Preoperative MR imaging of anal fistulas: does it really help the surgeon? Radiology 218:75–84. https://doi.org/10.1148/radiology.218.1.r01dc0575
Yildirim N, Gokalp G, Ozturk E, et al. (2011) Ideal combination of sequences for perianal fistula classification and evaluation of additional findings for readers with varying experience. Diagn Interv Radiol. https://doi.org/10.4261/1305-3825.DIR.4092-10.1
Oliveira IS, Kilcoyne A, Price MC, Harisinghani M (2017) MRI features of perianal fistulas: is there a difference between Crohn’s and non-Crohn’s patients? Abdom Radiol 42:1162–1168. https://doi.org/10.1007/s00261-016-0989-z
Cavusoglu M, Duran S, Sözmen Cılız D, et al. (2017) Added value of diffusion-weighted magnetic resonance imaging for the diagnosis of perianal fistula. Diagn Interv Imaging 98:401–408. https://doi.org/10.1016/j.diii.2016.11.002
Baik J, Kim SH, Lee Y, Yoon J-H (2017) Comparison of T2-weighted imaging, diffusion-weighted imaging and contrast-enhanced T1-weighted MR imaging for evaluating perianal fistulas. Clin Imaging 44:16–21. https://doi.org/10.1016/j.clinimag.2017.03.019
Singh K (2014) Magnetic resonance imaging (MRI) evaluation of perianal fistulae with surgical correlation. J Clin Diagn Res. https://doi.org/10.7860/JCDR/2014/7328.4417
Hori M, Oto A, Orrin S, Suzuki K, Baron RL (2009) Diffusion-weighted MRI: a new tool for the diagnosis of fistula in ano. J Magn Reson Imaging JMRI 30:1021–1026. https://doi.org/10.1002/jmri.21934
Acknowledgments
The authors thank Glenn Shingledecker for manuscript preparation.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
This study was not funded.
Ethical approval
This article does not contain any studies with human participants performed by any of the authors.
Disclosure
Noting to disclose.
Rights and permissions
About this article
Cite this article
Cattapan, K., Chulroek, T., Kordbacheh, H. et al. Contrast- vs. non-contrast enhanced MR data sets for characterization of perianal fistulas. Abdom Radiol 44, 446–455 (2019). https://doi.org/10.1007/s00261-018-1761-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-018-1761-3