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CC BY-NC-ND 4.0 · Journal of Coloproctology 2021; 41(03): 265-274
DOI: 10.1055/s-0041-1730260
Original Article

Magnetic Resonance Imaging of Perianal Fistulas in Clinically Symptomatic Patients and the Correlation Among Plain, Contrast, and Post Jelly MRI Fistulography

Ruchi Gupta 
1   Department of Radiodiagnosis, Indiragandhi Institute of Medical Sciences, Patna, Bihar, India
,
Subhash Kumar 
2   Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna, Bihar, India
,
Anil Kumar 
2   Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna, Bihar, India
,
Richa Tiwari 
3   Department of Radiodiagnosis, SMMH Medical College, Saharanpur, Uttar Pradesh, India
,
Neetu Sinha 
1   Department of Radiodiagnosis, Indiragandhi Institute of Medical Sciences, Patna, Bihar, India
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Abstract

Objectives To evaluate different types of perianal fistulas and their complications on magnetic resonance imaging (MRI) and to compare plain, contrast, and jelly magnetic resonance fistulography findings.

Materials and Methods This prospective study was performed in 30 patients who presented with perianal pus discharge or external fistulous opening. Magnetic resonance imaging of the perianal region before and after giving intravenous contrast and after injecting jelly through a percutaneous opening was performed on a 3T scanner and the results were correlated.

Results The mean age of the patients was 40.13 ± 13.88 years (range 19–75 years). The male to female ratio was 14:1. The most common type of fistula was St. James classification type I, which was seen in 13 patients (43%), followed by type IV in 30%, type III in 16%, type II in 6.66%, and type V in 3.33% of the patients. Using agreement analysis, we compared the number of primary and secondary tracts, internal openings, and horseshoe tracts and found a significant agreement between plain and post Jelly MRI fistulography (kappa statistic close to 1). When comparing plain and contrast MRI, there was significant agreement in the primary and secondary tracts, while statistically insignificant results were obtained (p > 0.05) for the horseshoe tract and internal openings. Contrast injection was helpful in 7 subjects (23.3%) as peripheral enhancement of abscesses were better delineated.

Conclusion Magnetic resonance imaging is the one stop diagnostic modality for perianal fistulas. Acquisition of axial (Ax) T2, axial T2 FS, coronal T2 and coronal T2 FS sequences without administering intravenous contrast or jelly is usually sufficient for the diagnosis of fistulas and their complications.

Keywords

fistulography - MRI - jelly - contrast - perianal - St. James classification


Publication History

Received: 29 August 2020

Accepted: 15 January 2021

Article published online:
19 July 2021

© 2021. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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