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Outcome after surgery for perianal fistula: predictive value of MR imaging
J A Spencer1, K Chapple, D Wilson
1Department of Radiology, St. James's University Hospital, Leeds, United Kingdom.
Objective:
The purpose of this study was to determine if MR findings are predictive of long-term outcome in a cohort of patients whose initial surgery was performed without access to the findings of MR imaging.
Subjects And Methods:
Forty patients with surgically proven perianal fistulas underwent preoperative dynamic contrast-enhanced MR imaging. The MR and surgical findings were independently recorded on an identical anatomic form. Three patients were subsequently lost to follow-up. The outcome for the remaining 37 patients was determined from surgical review, case notes, and questionnaires. Minimum follow-up period was 14 months (range, 14-39 months). Outcome was determined by one observer who was unaware of the initial MR grading and had not been present during surgery. Outcome was considered unsatisfactory if further surgery was required.
Results:
MR imaging was better than surgical exploration in predicting outcome (for MR imaging: positive predictive value, 73%; negative predictive value, 87%; sensitivity, 89%; and specificity, 68%; for surgical exploration: positive predictive value, 57%; negative predictive value, 64%; sensitivity, 73%; and specificity, 47%). MR classification of fistulas was significantly associated with outcome (p = .0004), and surgical classification was not significantly associated with outcome (p = .22, chi-square test). Also MR grades differed significantly for patients with satisfactory and unsatisfactory outcomes (p < .001, Mann-Whitney U test).
Conclusion:
MR imaging is valuable in the management of patients with perianal fistulas. MR imaging accurately reveals surgical anatomy and can be used to make better predictions regarding patient outcome than surgical findings.
Insights
Magnetic Resonance (MR) imaging provides better prediction of long-term outcomes for perianal fistula patients than surgical findings alone. MR imaging accurately visualizes anatomy, aiding in management decisions and improving patient outcome predictions.
Area of Science:
- Radiology
- Gastroenterology
- Surgical Outcomes
Background:
- Perianal fistulas are complex conditions requiring accurate diagnosis for effective management.
- Surgical exploration has limitations in fully characterizing fistula anatomy and predicting outcomes.
- The role of preoperative Magnetic Resonance (MR) imaging in guiding management and predicting outcomes for perianal fistulas warrants further investigation.
Purpose of the Study:
- To evaluate the predictive value of MR imaging findings for long-term outcomes in patients with perianal fistulas.
- To compare the predictive accuracy of MR imaging with surgical findings in determining patient outcomes.
- To assess the utility of MR imaging in the management of perianal fistula cases.
Main Methods:
- A cohort of 37 patients with surgically confirmed perianal fistulas underwent preoperative dynamic contrast-enhanced MR imaging.
- MR and surgical findings were independently documented.
- Patient outcomes were assessed based on surgical review, case notes, and questionnaires after a minimum 14-month follow-up period, with outcomes determined by an observer blinded to initial MR grading.
Main Results:
- MR imaging demonstrated superior predictive performance compared to surgical exploration (MR: sensitivity 89%, specificity 68%; Surgery: sensitivity 73%, specificity 47%).
- MR classification of fistulas was significantly associated with patient outcome (p = .0004), whereas surgical classification was not (p = .22).
- MR imaging grades showed significant differences between patients with satisfactory and unsatisfactory outcomes (p < .001).
Conclusions:
- MR imaging is a valuable tool in the management of perianal fistulas.
- Preoperative MR imaging accurately depicts surgical anatomy, enabling more reliable predictions of patient outcomes than surgical findings alone.
- The findings support the integration of MR imaging into the clinical pathway for perianal fistula management to improve patient care and outcomes.