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Practical MR Imaging of Anal Fistula Disease: How We Do It

Aim: A standard MRI technique of the pelvis is described which is well tolerated by patients and helps clinicians in surgical planning. Materials and methods: The clinical and imaging data of sixteen consecutive symptomatic men (mean age 45.5 ± 2 yrs, range 24-73 yrs) and fourteen women (mean age 40.6 ± 1.8 yrs, range 19-57 yrs) with known or suspected ano-perianal sepsis, who underwent MRI study between July 2015 and July 2016 were reviewed. The examinations were performed on a 1.5 T horizontal scanner using an external coil, T2–W and STIR pulse sequences in all three scan planes and an endoanal marker for evidence any intra o extra sphincteric collection, internal and external openings, distant extents and signs of disease activity despite apparent healing. The frequency, with which findings at MRI changed the preliminary clinical diagnosis and the subsequent surgical management from a simple fistula into that of complex fistula disease, was calculated. Results: The average time interval from the onset of symptoms to the request of MRI study was 13 ± 2 months (range 3-39 months) while only 5 out of 30 cases (16.6%) patients were evaluated with 3D endoanal-ultrasonography. Overall, in 27 out of 30 subjects (90%) a +440% increase in the rate of complex MR parameters was observed leading to need for reoperation and/or a more aggressive and extensive surgery. Conclusions: MRI is indicated as early as possible in the diagnostic work-up of anal fistula disease.


Piloni Vittorio, Chiavarini Marco, Fabbroni Luigi, Possanzini Marco, Bellido Aleman Maritza, Sartini Marika

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