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Comparison of MRI and Endoanal Ultrasound in Assessing Intersphincteric, Transsphincteric, and Suprasphincteric
Neda Akhoundi1, Javad Komijani Bozchelouei2, Alireza Abrishami3
1Radiology Department, Hillcrest Hospital, University of California San Diego, San Diego, USA.
Objectives:
Perianal fistula is a common disorder characterized by an anomalous perianal track connecting two epithelialized surfaces, most commonly the anal canal and the perianal skin. Although each has its limitations, magnetic resonance imaging (MRI) and endoanal ultrasound are currently two acceptable modalities for assessing perianal fistula. This study aimed to evaluate the accuracy of MRI and endoanal ultrasonography in diagosing perianal fistula, considering the surgical results as the references.
Methods:
This prospective cohort study was performed on patients with symptomatic perianal fistulas. MRI results of patients reported by the radiologist were collected along with the findings of endoanal ultrasonography performed by a gastroenterologist. These results were compared with surgical findings as the reference standard.
Results:
The study enrolled 126 patients. Exactly 222 definitive fistulas were identified during surgery. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ultrasound for perianal fistula were 87.38, 38.46, 92.38, 26.31, and 82.25% respectively; and for MRI were 76.12, 57.69, 93.88, 22.05, and 74.19% respectively. The accuracy of endoanal ultrasound for detecting transsphincteric and intersphincteric fistulas was higher than MRI. In contrast, the diagnostic value of MRI for detecting suprasphincteric fistulas was higher than endoanal ultrasound.
Conclusions:
Using endoanal ultrasonography to diagnose perianal fistulas is a relatively accurate method. This method may be more sensitive than MRI in detecting patients with perianal fistulas and abscesses.
Insights
Endoanal ultrasound shows higher accuracy than MRI for diagnosing most perianal fistulas. While MRI is better for suprasphincteric types, ultrasound is more sensitive overall for detecting these common anal canal conditions.
Area of Science:
- Gastroenterology
- Radiology
- Surgical Anatomy
Background:
- Perianal fistula is a common anal canal disorder.
- Magnetic resonance imaging (MRI) and endoanal ultrasound are accepted diagnostic modalities.
- Both imaging techniques have limitations in perianal fistula assessment.
Purpose of the Study:
- To evaluate and compare the diagnostic accuracy of MRI and endoanal ultrasonography for perianal fistulas.
- To determine the effectiveness of each imaging modality against surgical findings as the reference standard.
Main Methods:
- Prospective cohort study involving 126 patients with symptomatic perianal fistulas.
- Collected MRI and endoanal ultrasound findings.
- Compared imaging results with surgical outcomes.
Main Results:
- Endoanal ultrasound demonstrated higher accuracy (82.25%) than MRI (74.19%) for overall perianal fistula detection.
- Ultrasound showed superior accuracy for transsphincteric and intersphincteric fistulas.
- MRI exhibited higher diagnostic value for suprasphincteric fistulas.
Conclusions:
- Endoanal ultrasonography is a relatively accurate method for diagnosing perianal fistulas.
- Ultrasound may be more sensitive than MRI in identifying perianal fistulas and associated abscesses.
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