Role of magnetic resonance imaging in pre-operative assessment of ano-rectal fistula

Abstract

To evaluate the role of magnetic resonance imaging (MRI) in preoperative assessment of ano-rectal fistula and tracing its full extent and relationship. Twenty-four patients with ano-rectal fistula were enrolled in this study. They were examined with different MRI sequences for evaluation of the fistulas and their extent. Fistulas were classified according to St. James’s University Hospital MRI based classification system (which correlates the Parks surgical classification to anatomic MRI findings) into 5 grades. Then, interrelation between surgical and MRI findings was statistically analyzed with evaluation of the accuracy of each MRI sequence used. Grade 1 was the most frequent (37.5%) type of ano-rectal fistula. The most common location of the internal opening of the fistula was at 6 o’clock position. Combination of oblique coronal and axial planes of contrast-enhanced fat suppressed T1-weighed fast spin-echo (CE FS T1WFSE) sequence images showed the highest accuracy (99.4%) in diagnosis of ano-rectal fistula. MRI is a useful imaging tool in the preoperative assessment of ano-rectal fistula. A significant accordance between surgical and MRI findings was achieved by using combination of coronal and axial planes of CE FS T1WFSE sequence images.