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8.THE VALUE OF MAGNETIC RESONANCE IMAGING IN THE EVALUATION OF PERI-ANAL FISTULA

Authors: Ammar M. Jawad --- Mohammed A. kadhim محمد عبد كاظم --- Zainab K. Al-Jobouri --- Mohssin A.A. Hussain
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2018 Volume: 16 Issue: 2 Pages: 166-176
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background: Perianal fistula accounts for 0.01% of general population and is frequently managed inadequately resulting in a significant morbidity. Magnetic resonance imaging (MRI) plays an essential role in the preoperative assessment of the disease, therefore improving post-operative surgical outcome.Objective: To study the role of MRI in the evaluation of perianal fistula and to show the value of using contrast enhanced MR study in the determination of the precise tract pathway, extensions and other associated pathologies.Methods: A cross sectional analytic study was conducted on a total of 32 patients with perianal fistulas in the MRI Department of Al-Imamein Al-Kadhimein Medical City, Baghdad, Iraq during the period from November 2015 to December 2016. Patients underwent MRI examination using axial and coronal T2 weighted images with and without fat suppression and T1 fat suppressed sequences before and after contrast administration. The type of fistula, location of the internal opening, associated abscesses and/or sinus tracts and horseshoe extension were evaluated using different MR sequences. Results: The most common type of fistula encountered was the inter-sphincteric type, which was seen in 21 patients (66%), of those patients 16 fistulas (50%) were grade I and 5 fistulas (16%) were grade II. Trans-sphincteric fistulas were seen in 9 patients (28%), 2 of them (6%) were grade III and 7 fistulas (22%) were grade IV. Two patients (6%) had extra-sphincteric type. T2 weighted TSE, T2 TSE with fat suppression and T1 weighted fat suppressed post contrast sequences all show significant correlation with surgical results (with p-value less than 0.05) and the highest significance was obtained by the post contrast sequence (p-value of 0.00001). The highest accuracy in the diagnosis of fistula in ano was with the use of T1 enhanced fat suppressed sequence (98.8%) followed by 87% for the T2 fat suppression sequence and only 57% for the T2 weighted TSE sequence.Conclusion: MRI is an essential, noninvasive tool in the preoperative assessment of perianal fistulous tracks, with the axial and coronal post contrast fat suppression T1 providing the highest accuracy and clinical significance with surgical data and therefore giving a highly promising decrement in the incidence of post-operative complications.Keywords: MRI, perianal fistulaCitation: Jawad AM, kadhim MA, Al-Jobouri ZK, Hussain MAA. The value of magnetic resonance imaging in the evaluation of peri-anal fistula. Iraqi JMS. 2018; 16(2): 166-176. doi: 10.22578/IJMS.16.2.8

Keywords

MRI --- perianal fistula


Article
Role of MRI in assessment of perianal fistula
دور التصوير بالرنين المغناطيسي في تقييم الناسور حول الشرج

Authors: Hayam Yousif Odish --- Haven Azo Mohammed
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2017 Volume: 21 Issue: 2 Pages: 1789-1795
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objective: Perianal fistulae commonly occur in middle-aged men. It is important to determine the presence of fistula tracks, its grading and presence of abscess or inflammation. This study aimed to assess the role of MRI in diagnosis and classification of perianal fistula.Methods: This study included 20 patients with perianal sepsis that were referred to the MRI section of Radiology Department in Rizgary Teaching Hospital between August 2015 and April 2016. All patients underwent MRI examination.Results: The mean ± SD age of the 20 patients was 38.5 ± 10.4 years (range 22-55 years), of which 16 patients (80%) were males and four patients (20%) were females. Eighteen patients had a single external opening and two patients had two external opening. All the simple non-branching fistulas were successfully identified by axial and coronal planes of contrast enhanced T1Weighted image fast spin echo, of which five cases had simple intersphincter (G1) fistula and two had simple transphincter (G3), seven cases had intersphincter fistula either secondary tract or horse shoe and abscess (G2), five cases had complex transsphincter (G4). Two cases of complex G4 type had inflammation and edema in ischiorectal and ischioanal fossa and the internal openings were clearer in STIR T2axia.Conclusion: MRI non-invasively offers important information about perianal fistula that can reduce surgical complications and postoperative recurrence of the disease. Every patient with suspicious perianal sepsis should undergo MRI examination to prevent complications and morbidity.

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