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Preoperative MR Imaging of Anal Fistulas: Does It Really Help the Surgeon?¹

¹ From the Departments of Radiology (R.G.H.B.T., R.F.A.V., J.M.A.v.E.), Surgery (G.L.B., A.G.v.d.H., C.G.M.I.B.), and Clinical Epidemiology (A.G.H.K.), University Hospital of Maastricht, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands. From the 1999 RSNA scientific assembly. Received December 2, 1999; revision requested December 30; final revision received April 24, 2000; accepted May 8. Address correspondence to R.G.H.B.T. (e-mail: rbe@rdia.azm.nl).

PURPOSE: To evaluate the accuracy of magnetic resonance (MR) imaging with a quadrature phased-array coil for the detection of anal fistulas and to evaluate the additional clinical value of preoperative MR imaging, as compared with surgery alone.

MATERIALS AND METHODS: Fifty-six patients with anal fistulas underwent high-spatial-resolution MR imaging. Twenty-four had a primary fistula; 17, a recurrent fistula; and 15, a fistula associated with Crohn disease. MR imaging findings were withheld from the surgeon until surgery ended and verified, and surgery continued when required.

RESULTS: MR imaging provided important additional information in 12 (21%) of 56 patients. In patients with Crohn disease, the benefit was 40% (six of 15); in patients with recurrent fistulas, 24% (four of 17); and in patients with primary fistulas, 8% (two of 24). The difference between patients with or without Crohn disease and between patients with a simple fistula versus the rest was significant (P < .05). The sensitivity and specificity for detecting fistula tracks were 100% and 86%, respectively; abscesses, 96% and 97%, respectively; horseshoe fistulas, 100% and 100%, respectively; and internal openings, 96% and 90%, respectively.

CONCLUSION: High-spatial-resolution MR imaging is accurate for detecting anal fistulas. It provides important additional information in patients with Crohn disease–related and recurrent anal fistulas and is recommended in their preoperative work-up.

Index terms: Anus, abnormalities, 757.245 • Crohn disease, 74.262, 75.262 • Intestines, abnormalities, 74.262, 75.262, 757.245 • Magnetic resonance (MR), coils, 70.121411

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