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Using MRI to guide surgical strategy for perianal fistulas: from conventional acquisition to 3D modeling
Priscilla Ornellas Neves1,2, André Araújo de Medeiros Silva3,4
1Department of Radiology, Brasilia University Hospital, Brasília, DF, Brazil.
Abstract:
Magnetic resonance imaging (MRI) is the gold-standard imaging modality for evaluating perianal fistulas, playing a pivotal role in characterizing fistula anatomy and guiding optimal surgical strategies. Appropriate preoperative MRI assessment can significantly reduce recurrence rates and minimize the risk of complications, such as fecal incontinence. This article reviews the most relevant information that an MRI report should contain to aid effective surgical decision-making for perianal fistulas. These features influence therapeutic choices, including decisions regarding the suitability of techniques like fistulotomy, ligation of the intersphincteric fistula tract (LIFT), video-assisted anal fistula treatment (VAAFT), fistula-tract laser closure (FiLaC), and advancement flaps. The emerging role of three-dimensional (3D) modeling from MRI data is also discussed, highlighting its potential to enhance surgeons' spatial understanding of complex fistulous anatomy, thereby improving surgical planning, reducing operative time, and ultimately improving outcomes. However, the generation of accurate 3D models depends on meticulous image segmentation and interpretation by experienced radiologists. Future research directions, including the integration of 3D models with intraoperative navigation and standardized assessment of inflammatory activity, are also addressed in this review.
Insights
Magnetic resonance imaging (MRI) is crucial for perianal fistula evaluation, guiding surgical decisions to reduce recurrence and complications. Accurate MRI reports and 3D modeling enhance surgical planning and patient outcomes.
Area of Science:
- Radiology
- Gastroenterology
- Surgical Oncology
Background:
- Magnetic resonance imaging (MRI) is the gold-standard for perianal fistula evaluation.
- Preoperative MRI assessment is vital for reducing recurrence and complications like fecal incontinence.
Purpose of the Study:
- To review essential MRI report components for perianal fistula surgical decision-making.
- To discuss the role of 3D modeling in improving surgical planning and outcomes.
Main Methods:
- Review of current literature on MRI for perianal fistulas.
- Analysis of key features for surgical planning.
- Discussion of three-dimensional (3D) modeling techniques.
Main Results:
- Specific MRI findings guide choices among surgical techniques (e.g., fistulotomy, LIFT, VAAFT, FiLaC, advancement flaps).
- 3D modeling from MRI data enhances spatial understanding of complex anatomy.
- Accurate 3D models require expert radiologist interpretation and image segmentation.
Conclusions:
- Optimized MRI reporting is essential for effective perianal fistula treatment.
- 3D modeling shows promise for improving surgical planning and outcomes.
- Future research should focus on integrating 3D models with intraoperative navigation and standardized inflammation assessment.
