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Diffusion-weighted MRI: a new tool for the diagnosis of fistula in ano

Masatoshi Hori1, Aytekin Oto, Sarah Orrin

  • 1Department of Radiology, University of Chicago, Chicago, Illinois 60637, USA. mhori@radiol.med.osaka-u.ac.jp

Journal of Magnetic Resonance Imaging : JMRI
|October 27, 2009
PubMed
Abstract

Insights

Diffusion-weighted magnetic resonance imaging (MRI) aids T2-weighted imaging in detecting anal fistulae, offering comparable sensitivity to gadolinium-enhanced MRI. This combination improves diagnostic confidence, especially for patients who cannot receive contrast agents.

Area of Science:

  • Radiology
  • Medical Imaging

Background:

  • Anal fistulae are complex anorectal conditions requiring accurate imaging for diagnosis and management.
  • Magnetic resonance imaging (MRI) is a key modality for evaluating anal fistulae, with T2-weighted imaging being standard.
  • Gadolinium (Gd)-enhanced MRI has been used, but carries risks for certain patient populations.

Purpose of the Study:

  • To evaluate the added value of diffusion-weighted MRI (DW-MRI) to T2-weighted MRI for anal fistula detection.
  • To compare the diagnostic performance of DW-MRI combined with T2-weighted imaging against Gd-enhanced T2-weighted imaging.

Main Methods:

  • Retrospective analysis of 20 anal fistulae in 13 patients.
  • Imaging protocol included fat-suppressed T2-weighted, diffusion-weighted (b=800 s/mm(2)), and fat-suppressed Gd-enhanced T1-weighted sequences.
  • Consensus review by two radiologists.

Main Results:

  • T2-weighted imaging detected 90% of fistulae; combined DW-MRI and T2-weighted imaging detected 95%; combined Gd-enhanced and T2-weighted imaging detected 95%.
  • No significant difference in sensitivity between techniques.
  • Diagnostic confidence was significantly higher with combined DW-MRI/T2-weighted and combined Gd-enhanced/T2-weighted imaging compared to T2-weighted imaging alone.

Conclusions:

  • Diffusion-weighted MRI is a valuable sequence for anal fistula evaluation.
  • DW-MRI serves as a useful adjunct to T2-weighted imaging.
  • DW-MRI is particularly beneficial for patients with contraindications to contrast agents.

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