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Role of Magnetic Resonance Fistulogram in Preoperative Assessment of Anorectal Fistulas: A Prospective Observational
Purnachandra Lamghare1, Richa Mariam Roy1, George B Mangalath2
1Department of Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (DPU), Pimpri-Chinchwad, Maharashtra, India.
Background:
Anorectal fistulas (AFs) are chronic inflammatory conditions featured by abdominal tracts linking the anal canal to the perineal skin, and precise delineation of such tracts is essential for effective surgical management. Magnetic resonance (MR) fistulogram clearly visualizes fistulous pathways and associated abscesses. However, literature remains limited on its association with intraoperative findings. Thus, the present study explored the role of MR fistulogram in the preoperative assessment of AFs.
Materials And Methods:
This prospective observational study was conducted over 2 years (January 2024-December 2025) in the Department of Radiodiagnosis. The study included 125 adult patients of AF confirmed via clinical examination as well as radiological investigations, and scheduled for surgical intervention. MR fistulogram characteristics were noted, and the findings were confirmed with intraoperative observations.
Results:
Patients were predominantly female (87.2%), with a mean age of 42.6 ± 13.2 years. Most patients presented within 1-6 months of symptom onset (40.8%), while perianal tenderness and external opening at the left perineum were common clinical findings (each 18.4%). According to the St. James University Hospital classification, Grade 1 (34.4%) and Grade 4 (26.4%) fistulas were most common. In all patients (100%), magnetic resonance imaging findings were confirmed intraoperatively. Fistula grades were significantly associated with male sex ( P = 0.020), but not with age groups ( P = 0.421) and duration of symptoms ( P = 0.767).
Conclusions:
MR fistulogram had strong concordance with intraoperative findings, with male sex being significantly associated with fistula grades, thereby highlighting demographic dependency in preoperative AF assessment.
Insights
Magnetic resonance (MR) fistulogram accurately assesses anorectal fistulas (AFs), showing high concordance with surgical findings. Male sex was significantly associated with fistula grades, indicating demographic factors in preoperative AF evaluation.
Area of Science:
- Radiology
- Gastroenterology
- Surgical Anatomy
Background:
- Anorectal fistulas (AFs) are complex tracts requiring precise surgical delineation.
- Magnetic resonance (MR) fistulogram is a key imaging modality for visualizing AFs and associated abscesses.
- Limited data exists on the correlation between MR fistulogram findings and intraoperative observations.
Purpose of the Study:
- To evaluate the accuracy of MR fistulogram in preoperative assessment of anorectal fistulas.
- To determine the concordance between MR fistulogram findings and intraoperative surgical outcomes.
- To explore demographic associations with anorectal fistula grades.
Main Methods:
- A prospective observational study included 125 adult patients with confirmed anorectal fistulas undergoing surgery.
- MR fistulogram characteristics were recorded and compared with intraoperative findings.
- Statistical analysis assessed associations between fistula grades and demographic factors.
Main Results:
- MR fistulogram demonstrated 100% concordance with intraoperative findings in all patients.
- Grade 1 and Grade 4 fistulas were most prevalent according to the St. James University Hospital classification.
- Fistula grades showed a significant association with male sex (P = 0.020).
Conclusions:
- MR fistulogram is a highly reliable tool for preoperative anorectal fistula assessment.
- The study highlights a significant association between male sex and anorectal fistula grades.
- Demographic factors, particularly sex, should be considered in the preoperative evaluation of anorectal fistulas.
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