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Updated: Jun 5, 2026

Quantification of Levator Ani Hiatus Enlargement by Magnetic Resonance Imaging in Males and Females with Pelvic Organ Prolapse
07:41

Quantification of Levator Ani Hiatus Enlargement by Magnetic Resonance Imaging in Males and Females with Pelvic Organ Prolapse

Published on: April 17, 2019

Precise and Comprehensive Evaluation of Unenhanced Magnetic Resonance Fistulogram in Patients with Perianal Fistula

J Prithvi Raj1, Satish D Patil, Pavan Kolekar

  • 1Department of Radiodiagnosis, Shri B.M. Patil Medical College, Hospital and Research Centre and BLDE (Deemed to be University), Vijayapura, Karnataka, India.

Annals of African Medicine
|June 3, 2026
PubMed
Abstract

Insights

Unenhanced magnetic resonance imaging (MRI) accurately maps perianal fistulas, proving effective for preoperative assessment. This contrast-free approach is suitable as a first-line imaging strategy.

Area of Science:

  • Radiology
  • Gastroenterology
  • Surgical Anatomy

Background:

  • Precise anatomical delineation of perianal fistulas is crucial for surgical planning.
  • Conventional MRI protocols often utilize gadolinium contrast, posing risks and increasing costs.
  • The diagnostic value of unenhanced MRI for perianal fistulas requires validation.

Purpose of the Study:

  • To assess the diagnostic accuracy and clinical utility of unenhanced MRI fistulography.
  • To evaluate preoperative perianal fistula assessment using Parks and St. James classification systems.
  • To compare unenhanced MRI findings with surgical outcomes as the reference standard.

Main Methods:

  • Prospective single-center study of 84 patients with suspected perianal fistula.
  • Unenhanced 1.5-T MRI with multiplanar T1 and fat-suppressed T2 sequences.
  • Independent radiologist assessment of fistula components and classification using Parks and St. James systems.

Main Results:

  • High MRI-surgical agreement: 98.8% for primary tracts, 97.6% for internal openings.
  • Excellent sensitivity (100%) and specificity (98.0%) for secondary tract detection.
  • 100% diagnostic accuracy for horseshoe extensions and abscesses; high concordance with classification systems.

Conclusions:

  • Unenhanced MRI offers accurate and reliable preoperative mapping of perianal fistulas.
  • This contrast-free technique is suitable for first-line imaging.
  • Routine gadolinium contrast may not be necessary for perianal fistula MRI assessment.
Keywords:
Fistulographie par résonance magnétiqueMagnetic resonance fistulographyParks classificationSt. James classificationclassification de Parksclassification du St. Jamesfistule périanaleimagerie par résonance magnétique sans injectionperianal fistulaunenhanced magnetic resonance imaging

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