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Published on: April 17, 2019
Preoperative Assessment of Perianal Fistulas with Combined Magnetic Resonance and Tridimensional Endoanal Ultrasound:
Nikolaos Varsamis1, Christoforos Kosmidis1, Grigorios Chatzimavroudis2
1Third Surgical Department, "AHEPA" University Hospital, Medical Faculty, Aristotle University of Thessaloniki, 1 Kiriakidi Street, 54636 Thessaloniki, Greece.
Background:
we designed a prospective study of diagnostic accuracy that compared pelvic MRI and 3D-EAUS with pelvic MRI alone in the preoperative evaluation and postoperative outcomes of patients with perianal fistulas.
Methods:
the sample size was 72 patients and this was divided into two imaging groups. MRI alone was performed on the first group. Both MRI and 3D-EAUS were performed in parallel on the second group. Surgical exploration took place after two weeks and was the standard reference. Park's classification, the presence of a concomitant abscess or a secondary tract, and the location of the internal opening were recorded. All patients were re-evaluated for complete fistula healing and fecal incontinence six months postoperatively. All of the collected data were subjected to statistical analysis.
Results:
the MRI group included 36 patients with 42 fistulas. The MRI + 3D-EAUS group included 36 patients with 46 fistulas. The adjusted sensitivity and negative predictive value were 1.00 for most fistula types in the group that underwent combined imaging. The adjusted specificity improved for intersphincteric fistulas in the same group. The adjusted balanced accuracy improved for all fistula types except rectovaginal. The combination of imaging methods showed improved diagnostic accuracy only in the detection of a secondary tract. The healing rate at six months was 100%. Fecal incontinence at six months did not present a statistically significant difference between the two groups (Fisher's exact test p-value > 0.9). Patients with complex perianal fistulas had a statistically significant higher probability of undergoing a second surgery (x2 test p-value = 0.019).
Conclusions:
the combination of pelvic MRI and 3D-EAUS showed improved metrics of diagnostic accuracy and should be used in the preoperative evaluation of all patients with perianal fistulas, especially those with complex types.
Insights
Combining pelvic MRI and 3D-EAUS improves diagnostic accuracy for perianal fistulas. This enhanced preoperative evaluation, especially for complex cases, leads to better surgical outcomes and patient healing.
Area of Science:
- Gastroenterology
- Radiology
- Surgical Innovation
Background:
- Perianal fistulas require accurate preoperative evaluation for optimal surgical outcomes.
- Pelvic MRI and 3D Endoscopic Ultrasound (3D-EAUS) are key imaging modalities.
Purpose of the Study:
- To compare the diagnostic accuracy of combined pelvic MRI and 3D-EAUS versus pelvic MRI alone.
- To evaluate the impact on preoperative assessment and postoperative outcomes in perianal fistula patients.
Main Methods:
- A prospective diagnostic accuracy study involving 72 patients with perianal fistulas.
- Patients were divided into two groups: MRI alone, and MRI with 3D-EAUS.
- Surgical exploration served as the reference standard; outcomes included fistula healing and fecal incontinence at six months.
Main Results:
- Combined MRI and 3D-EAUS demonstrated improved diagnostic accuracy, particularly for detecting secondary tracts.
- Enhanced sensitivity and negative predictive value were observed for most fistula types with combined imaging.
- No significant difference in fecal incontinence rates was found between groups; 100% healing rate at six months.
Conclusions:
- The combination of pelvic MRI and 3D-EAUS offers superior diagnostic metrics for perianal fistulas.
- This combined approach is recommended for preoperative evaluation, especially in complex fistula cases.
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