Magnetic resonance imaging of anal fistulae

Success of surgery for an anal fistula depends on accurate assessment of the fistula; however, such assessment is technically difficult. We have done a prospective study that determined the accuracy of magnetic resonance imaging (MRI) in demonstrating the course of fistulae, by comparing MRI scan interpretations with subsequent operative findings. 16 patients (mean [range] age 42 [24-66] years) had MRI followed by surgery within a mean of 22 (1-101) days. MRI scan interpretations agreed precisely with independently documented operative findings in 14 of 16 patients. MRI is an accurate method of delineating anal fistulae, and should be considered for patients with difficult fistulae that recur despite skilled attention because it demonstrates abnormalities that might otherwise be missed.