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Aggarwal P, Malik R, Sarawagi R, Kumar A. Comparing the Efficacy of a Combination of Diffusion-Weighted Imaging and T2-STIR (Short Tau Inversion Recovery) Imaging With Contrast-Enhanced MRI in the Evaluation of Perianal Fistula. Cureus 2024; 16:e53485. [PMID: 38440010 PMCID: PMC10910302 DOI: 10.7759/cureus.53485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Perianal fistula is clinically diagnosed and commonly characterized using magnetic resonance imaging (MRI). Diffusion-weighted imaging (DWI) and T2-weighted imaging are emerging techniques that can obviate the need for contrast injection in cases where contrast administration is not feasible or contraindicated. The main objective of our study was to compare the efficacy of the combination of DWI and T2 STIR (short tau inversion recovery) imaging with contrast-enhanced MRI for the diagnosis and characterization of perianal fistula. METHODS Sixty-nine patients with clinical perianal fistula with at least one external opening were evaluated with DWI, T2 STIR, and contrast MRI. A comparative cross-sectional study was conducted in the Department of Radiodiagnosis and Imaging, All India Institute of Medical Sciences, Bhopal, India. The chi-square test was done to find the association between categorical variables. The Kappa test was done to estimate the agreement between two different tests in measuring the outcome. The validity of tests was measured using sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. RESULTS The combination of DWI and T2 STIR is equivalent to contrast-enhanced MRI in the evaluation of primary and complicated perianal fistula. The combination of DWI and T2 STIR is superior to DWI alone in the classification and characterization of perianal fistula. However, DWI is superior to T2 STIR in differentiating perianal inflammation with abscess from perianal inflammation without abscess and can be used as an alternative to post-contrast fat-suppressed T1-WI in the detection of perianal abscesses and disease activity. CONCLUSION DWI can be used as an adjunct to T2 STIR, and the combination of DWI and T2 STIR can replace the post-contrast fat-suppressed T1 MRI sequence in the classification and characterization of perianal fistula.
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Affiliation(s)
- Pooja Aggarwal
- Radiology, All India Institute of Medical Sciences, Bhopal, IND
| | - Rajesh Malik
- Radiology, All India Institute of Medical Sciences, Bhopal, IND
| | - Radha Sarawagi
- Radiology, All India Institute of Medical Sciences, Bhopal, IND
| | - Aman Kumar
- Radiology, All India Institute of Medical Sciences, Bhopal, IND
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Ahmad A, Roplekar S, Podlasek A. Can Short Tau Inversion Recovery (STIR) Imaging Be Used as a Stand-Alone Sequence To Assess a Perianal Fistulous Tract on MRI? A Retrospective Cohort Study Comparing STIR and T1-Post Contrast Imaging. Cureus 2024; 16:e52448. [PMID: 38371039 PMCID: PMC10871160 DOI: 10.7759/cureus.52448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
INTRODUCTION Perianal fistulas demand precise preoperative assessment for optimal surgical outcomes. MRI, using Short Tau Inversion Recovery (STIR) and T1-post contrast sequences, plays a crucial role in this evaluation.This retrospective cohort study compared STIR imaging's diagnostic efficacy with T1-post contrast sequences in identifying perianal fistulous tracts. The study investigated whether STIR imaging could serve as the sole diagnostic sequence, simplifying clinical practice. METHODS In a tertiary care hospital, 100 patients underwent pelvic MRI for suspected perianal fistulas. Radiologists independently evaluated STIR and T1-post contrast sequences for internal openings, tract extent, distinction, abscess presence, and tract type. Sensitivity, specificity, area under the curve (AUC), and Cohen's kappa analysis were used for diagnostic assessment. RESULTS STIR imaging showed notable sensitivity (79.8-97.9%) and specificity (100%) for identifying internal openings and tracts. Combined with T1-post contrast, diagnostic accuracy improved significantly, with near-perfect AUC values. Kappa values indicated moderate to substantial agreement between radiological assessments and clinical diagnosis. The combined sequences achieved 100% sensitivity and specificity for tract visualization. CONCLUSION STIR imaging presents promise as a singular diagnostic tool for perianal fistulas, especially when combined with T1-post contrast sequences. While offering potential clinical diagnosis simplifications, further studies are warranted to validate its utility and ensure comprehensive diagnostic accuracy.
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Affiliation(s)
| | | | - Anna Podlasek
- Tayside Innovation MedTech Ecosystem (TIME), University of Dundee, Dundeee, GBR
- Radiological Sciences, University of Nottingham, Nottingham, GBR
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KV A, Arunachalam VK, Sherene H, Ethiraju V, Ranganathan R, SM G, Rajasekaran S, Mehta P, Cherian M. Comparison of Contrast-Enhanced 3D Imaging with 2D Imaging in the Evaluation of Perianal Fistula at 3T: A Prospective Observational Study. Indian J Radiol Imaging 2024; 34:95-102. [PMID: 38106872 PMCID: PMC10723969 DOI: 10.1055/s-0043-1775738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Introduction Perianal fistula and its recurrence is a challenging entity for surgeons. It is a well-establi1shed fact that magnetic resonance imaging (MRI) findings influence surgical procedures and reduce the rate of recurrence. In this study, we assessed the contrast-enhanced (CE) three dimensional T1 sequences [sampling perfection with application optimized contrast using different flip angle evolution (SPACE) and volumetric interpolated breath-hold examination (VIBE)] in a 3T MRI system to evaluate perianal fistulas and compared them with two-dimensional (2D) sequences. Materials and Methods Forty-four patients (mean age, 38.8 ± 15.3 [standard deviation]; 32 males, 12 females) with perianal fistula were included in this prospective study. The patients underwent conventional noncontrast, 2D sequences, diffusion-weighted imaging, followed by postcontrast, 2D T1 images in both axial and coronal planes, and 3D sequences at 3T. Acquisition times were recorded for each sequence. Each postcontrast sequence was evaluated in terms of image quality, presence of artifacts, fistula type, presence of an abscess, visibility, and number of internal orifices. The surgical findings were considered the gold standard. The imaging findings were compared with the surgical findings. Results In all three sequences, the fistula type and abscess were identified correctly in all patients. The sensitivity value for identification of ramifications utilizing CE 3D T1 VIBE sequence, CE 3D T1 SPACE, and CE 2D T1 images was 100, 86, and 36%, respectively. The number of internal orifices was identified by the CE 3D T1 VIBE and CE 3D T1 SPACE sequences in 100 and 92% of patients, respectively. CE 2D T1 images correctly identified internal orifices in 80% of patients. The overall scan time for each 3D sequence was shorter than for the combined postcontrast 2D sequences. Conclusion CE 3D T1 SPACE and CE 3D T1 VIBE sequences outperformed conventional CE 2D sequences in the evaluation of perianal fistulas in terms of visibility and the number of internal orifices with a shorter scanning time. Among the 3D sequences, CE 3D T1 VIBE is slightly superior to CE 3D T1 SPACE sequence.
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Affiliation(s)
- Abdulla KV
- Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | | | - Haleema Sherene
- Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - Vijayakumaran Ethiraju
- Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - Rupa Ranganathan
- Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - Gowtham SM
- Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - Sriman Rajasekaran
- Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - Pankaj Mehta
- Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - Mathew Cherian
- Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
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Levy AD, Liu PS, Kim DH, Fowler KJ, Bharucha AE, Chang KJ, Cilenti E, Gage KL, Garcia EM, Kambadakone AR, Korngold EK, Marin D, Moreno C, Pietryga JA, Santillan CS, Weinstein S, Wexner SD, Carucci LR. ACR Appropriateness Criteria® Anorectal Disease. J Am Coll Radiol 2021; 18:S268-S282. [PMID: 34794588 DOI: 10.1016/j.jacr.2021.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 01/06/2023]
Abstract
This review summarizes the relevant literature for the selection of the initial imaging in 4 clinical scenarios in patients with suspected inflammatory disease or postoperative complication of the anorectum. These clinical scenarios include suspected perianal fistula or abscess; rectovesicular or rectovaginal fistula; proctitis or pouchitis; and suspected complication following proctectomy, coloproctectomy, or colectomy with a pouch or other anastomosis. The appropriateness of imaging modalities as they apply to each clinical scenario is rated as usually appropriate, may be appropriate, and usually not appropriate to assist the selection of the most appropriate imaging modality in the corresponding clinical scenarios of anorectal disease. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Angela D Levy
- Medstar Georgetown University Hospital, Washington, District of Columbia.
| | - Peter S Liu
- Section Head, Abdominal Imaging, Cleveland Clinic, Cleveland, Ohio
| | - David H Kim
- Panel Chair, University of Wisconsin Hospital & Clinics, Madison, Wisconsin
| | - Kathryn J Fowler
- Panel Vice-Chair, University of California San Diego, San Diego, California; and Founder, Advisory Board Quantix Bio
| | - Adil E Bharucha
- Chair of the Neurogastroenterology Section, Chair of Research Compliance Subcommittee, and Medical Director, Office of Clinical Trials, Mayo Clinic Rochester, Minnesota; and American Gastroenterological Association
| | - Kevin J Chang
- Boston University Medical Center, Boston, Massachusetts
| | - Elizabeth Cilenti
- Medstar Georgetown University Hospital, Washington, District of Columbia, Primary care physician
| | - Kenneth L Gage
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida; SECJNMMI Member-at-Large
| | - Evelyn M Garcia
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Avinash R Kambadakone
- Massachusetts General Hospital, Boston, Massachusetts; Taubman Museum of Art Board Member; and Past-President VA Rad Society
| | - Elena K Korngold
- Section Chief, Abdominal Imaging, Oregon Health and Science University, Portland, Oregon
| | - Daniele Marin
- Duke University Medical Center, Durham, North Carolina
| | - Courtney Moreno
- Emory University, Atlanta, Georgia; Chair ACR CTC Registry Committee; and Executive Council American Roentgen Ray Society
| | - Jason A Pietryga
- University of Alabama at Birmingham, Birmingham, Alabama; Associate Editor Hollow Organ GI
| | - Cynthia S Santillan
- Chief, Body Imaging Division and Vice-Chair, Clinical Operations for Radiology, University of California San Diego, San Diego, California
| | | | - Steven D Wexner
- Cleveland Clinic Florida, Weston, Florida; Editor-in-Chief, Surgery Journal; American College of Surgeons PAC Board; and Managing Member, Unique Surgical Innovations
| | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia; Director of CT and MRI at VCU, Section Chief, Abdominal Imaging at VCU
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Perianal fistula imaging: a comparison between two-channel superficial Flex coil and eight-channel body coil. Pol J Radiol 2020; 84:e430-e435. [PMID: 31969962 PMCID: PMC6964328 DOI: 10.5114/pjr.2019.89906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 09/25/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose Perianal fistula is an important health problem with devastating morbidity. For diagnosis and prevention of recurrence, perianal fistula imaging (PFI) is crucial. The aim of this study was to investigate if a Flex-M superficial coil images would provide more information than images obtained with a phased-array body coil in PFI. Material and methods Thirty-one fistulas of 29 patients were prospectively evaluated with magnetic resonance imaging. A phased-array body coil was used in all patients as in routine practice, and sequences with Flex-M coil were also obtained. Afterwards, images were evaluated by two experienced radiologists who were blinded to the patients, coil and also to each other. The site of internal and external openings, and presence or absence of abscess and secondary tracts were recorded. Results The conspicuity of images was better with the Flex-M coil. Both radiologists saw more internal openings with the Flex-M coil. Cohen’s κ value was 0.100 (p = 0.201) for Reader 1 and 0.110 (p = 0.361) for Reader 2 between these two coils. Additionally, numerically more internal/external openings and secondary tracts were seen by both readers. Interobserver variability was not statistically significant, and Cohen’s κ values signifyied good concordance between readers. Conclusions In our study we showed that multichannel superficial phased-array coils improved imaging quality in PFI. We think that Flex-M coil can easily be used in routine clinical practice to gather better images of perianal fistulas.
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Feng ST, Huang M, Dong Z, Xu L, Li Y, Jia Y, Cai H, Shen B, Li ZP. MRI T2-Weighted Imaging and Fat-Suppressed T2-Weighted Imaging Image Fusion Technology Improves Image Discriminability for the Evaluation of Anal Fistulas. Korean J Radiol 2019; 20:429-437. [PMID: 30799574 PMCID: PMC6389820 DOI: 10.3348/kjr.2018.0260] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 11/02/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
- Shi Ting Feng
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Mengqi Huang
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhi Dong
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ling Xu
- Faculty of Medicine and Dentistry, University of Western Australia, Perth, Australia
| | - Yin Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yingmei Jia
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Huasong Cai
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Bingqi Shen
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zi Ping Li
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
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Jabeen N, Qureshi R, Sattar A, Baloch M. Diagnostic Accuracy of Short Tau Inversion Recovery as a Limited Protocol for Diagnosing Perianal Fistula. Cureus 2019; 11:e6398. [PMID: 31942266 PMCID: PMC6961795 DOI: 10.7759/cureus.6398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction Perianal fistula refers to abnormal communication between perianal skin and anal canal. Magnetic resonance imaging (MRI) and endoanal ultrasound have been used in the evaluation of perianal fistula. Endoanal ultrasound is a cost-effective but operator-dependent technique. MRI provides accurate details regarding anal canal anatomy and effectively identifies the fistulae. For evidence-based care, a cost-effective and an accurate imaging modality is required in a developing country. Therefore, the aim of this study was to determine the diagnostic accuracy of short tau inversion recovery (STIR) as a limited protocol MRI pelvis in diagnosing perianal fistula taking surgical findings as the gold standard. Materials and methods A retrospective review of MRI pelvis from 1st February 2018 to 1st July 2018 was undertaken. Patients of any age or gender suspected to have perianal fistula were included. One radiologist interpreted the complete MRI pelvis and the other radiologist only viewed axial and coronal STIR sequences as a limited protocol. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of axial and coronal STIR sequence were calculated taking surgical findings as the gold standard. Results In total, 150 patients were included in this study. The mean age of the patients was 43.20 ± 13.75 years. In total, 122 (81.3%) were males and 28 (18.7%) were females. Using STIR as a limited protocol, fistulae were found in 125 (83.3%) patients, whereas on surgery, the fistulae were found in 119 (79.3%) patients. Sensitivity, specificity, PPV, NPV, and diagnostic accuracy of STIR as limited protocol MRI pelvis in diagnosing perianal fistulae was found to be 96.6%, 67.7%, 92.0%, 84.0%, and 90.6%, respectively, taking surgical findings as the gold standard. Conclusion STIR has high sensitivity and diagnostic accuracy in diagnosing in the perianal fistula. Using STIR as a limited protocol in a developing country can help improving patient care by accurately diagnosing perianal fistulae. Moreover, it is recommended that further studies for identifying internal opening on STIR should also be carried out to improve patient care.
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Affiliation(s)
- Naila Jabeen
- Radiology, Dow University of Health Sciences, Karachi, PAK
| | - Ruby Qureshi
- Radiology, Dow University of Health Sciences, Karachi, PAK
| | - Amjad Sattar
- Radiology, Dow University of Health Sciences, Karachi, PAK
| | - Musarat Baloch
- Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
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Gu C, Wang Y, Lai L, Han W, Li J, Xing H, Huo Y, Li C, Bai K. A comparable method to Gd-contrast enhancement in the preoperative evaluation of anal fistula. Medicine (Baltimore) 2019; 98:e17807. [PMID: 31689864 PMCID: PMC6946531 DOI: 10.1097/md.0000000000017807] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
To explore a comparable method to Gd-contrast enhancement in the preoperative evaluation of anal fistula to evaluate its morphology changes.Forty-six patients with anal fistula were enrolled. Each patient acquired a 3.0T magnetic resonance imaging (MRI) routine sequence, diffusion-weighted imaging (DWI) sequence and fat suppression T1 weighted imaging (FS T1WI) contrast enhancement (CE) scanning. To record the morphology performances of the internal orifice and the fistulas on the transverse images of fat suppression T2 weighted imaging (FS T2WI), DWI, FS T2WI combined with DWI, FS T1WI Gd-CE, with the standard of the surgical pathology results. Two observers evaluated images in consensus. The conspicuity and the diagnostic performance rate were compared between the 4 imaging data sets.The consistencies of interobservers about the conspicuity scores and the diagnostic performance rates of the internal orifice and the fistula were good. The conspicuity of the internal orifice was higher for the set of FS T2WI, FS T2WI+DWI, and FS T1WI+CE than DWI. The diagnostic performance rate of the internal orifice was higher for the set of FS T2WI, FS T2WI+DWI, and FS T1WI+CE than DWI. The conspicuity of the fistula was higher for the set of FS T2WI+DWI and FS T1WI+CE than FS T2WI or DWI. There were no significantly differences between the 4 sets of FS T2WI, DWI, FS T2WI+DWI, and FS T1WI+CE in the diagnostic performance rate of the fistula.The set of FS T2WI combined with DWI was comparable to FS T1WI CE in evaluation of anal fistula morphology changes.
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Affiliation(s)
- Chao Gu
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong
| | - Yu Wang
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong
| | - Lixia Lai
- China-Japan Friendship Hospital, Beijng
| | - Weiwei Han
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong
| | - Jiansheng Li
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong
| | - Haichang Xing
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong
| | - Yongjun Huo
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong
| | - Chuanting Li
- Shandong Medical Imaging Research Institute, Jinan, Shandong, China
| | - Keyun Bai
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong
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Erlichman DB, Kanmaniraja D, Kobi M, Chernyak V. MRI anatomy and pathology of the anal canal. J Magn Reson Imaging 2019; 50:1018-1032. [PMID: 31115134 DOI: 10.1002/jmri.26776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/21/2019] [Accepted: 04/22/2019] [Indexed: 12/11/2022] Open
Abstract
The normal function of the anal sphincter complex is crucial for quality of life, as it is the mechanism by which fecal continence is maintained. Additionally, the anal sphincter complex is an integral part of the coordinated effort of defecation. As imaging plays an important role in assessment of pathologic conditions involving the anal region, understanding the normal anatomy of the anal sphincter complex is important for correct image interpretation and accurate diagnosis. This review discusses the anatomy and function of the anal sphincter complex, important technical considerations for MRI, and various inflammatory, infectious, and neoplastic processes, as well as pathologic structural conditions that affect the anal region. Level of Evidence: 5 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2019;50:1018-1032.
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Affiliation(s)
- David B Erlichman
- Department of Radiology, Montefiore Medical Center, Bronx, New York, USA
| | | | - Mariya Kobi
- Department of Radiology, Montefiore Medical Center, Bronx, New York, USA
| | - Victoria Chernyak
- Department of Radiology, Montefiore Medical Center, Bronx, New York, USA
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Sturm A, Maaser C, Calabrese E, Annese V, Fiorino G, Kucharzik T, Vavricka SR, Verstockt B, van Rheenen P, Tolan D, Taylor SA, Rimola J, Rieder F, Limdi JK, Laghi A, Krustiņš E, Kotze PG, Kopylov U, Katsanos K, Halligan S, Gordon H, González Lama Y, Ellul P, Eliakim R, Castiglione F, Burisch J, Borralho Nunes P, Bettenworth D, Baumgart DC, Stoker J. ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 2: IBD scores and general principles and technical aspects. J Crohns Colitis 2019; 13:273-284. [PMID: 30137278 DOI: 10.1093/ecco-jcc/jjy114] [Citation(s) in RCA: 236] [Impact Index Per Article: 47.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Andreas Sturm
- Department of Gastroenterology, DRK Kliniken Berlin I Westend, Berlin, Germany
| | - Christian Maaser
- Outpatients Department of Gastroenterology, Hospital Lüneburg, Lüneburg, Germany
| | - Emma Calabrese
- Department of Systems Medicine, University of Rome, Tor Vergata, Italy
| | - Vito Annese
- Department of Gastroenterology, Valiant Clinic & American Hospital, Dubai, UAE
| | - Gionata Fiorino
- Department of Gastroenterology, Humanitas Clinical and Research Institute, Milan, Italy
| | - Torsten Kucharzik
- Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Lüneburg, Germany
| | | | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven and CHROMETA - Translational Research in Gastrointestinal Disorders, KU Leuven, Belgium
| | - Patrick van Rheenen
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, University Medical Center Groningen, Groningen, The Netherlands
| | - Damian Tolan
- Clinical Radiology, St James's University Hospital, Leeds, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Jordi Rimola
- Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Florian Rieder
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jimmy K Limdi
- Department of Gastroenterology, Pennine Acute Hospitals NHS Trust, Manchester; Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Andrea Laghi
- Department of Clinical and Surgical Translational Medicine, Sapienza - University of Rome, Rome, Italy
| | - Eduards Krustiņš
- Department of Gastroenterology, Hepatology and Nutrition, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Paulo G Kotze
- Colorectal Surgery Unit, Catholic University of Paraná PUCPR, Curitiba, Brazil
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv, Israel
| | - Konstantinos Katsanos
- Department of Gastroenterology and Hepatology, University and Medical School of Ioannina, Ioannina, Greece
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| | - Hannah Gordon
- Section of Gastroenterology & Hepatology, Royal London Hospital, London, UK
| | - Yago González Lama
- Department of Gastroenterology, University Hospital Puerta De Hierro, Majadahonda Madrid, Spain
| | - Pierre Ellul
- Department of Medicine, Mater Dei Hospital, Msida, Malta
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv, Israel
| | - Fabiana Castiglione
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - Johan Burisch
- Department of Gastroenterology, North Zealand University Hospital; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Paula Borralho Nunes
- Department of Anatomic Pathology, Hospital Cuf Descobertas; Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Dominik Bettenworth
- Department of Medicine B, Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany
| | - Daniel C Baumgart
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Academic Medical Center AMC, University of Amsterdam, Amsterdam, The Netherlands
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Brillantino A, Iacobellis F, Reginelli A, Monaco L, Sodano B, Tufano G, Tufano A, Maglio M, De Palma M, Di Martino N, Renzi A, Grassi R. Preoperative assessment of simple and complex anorectal fistulas: Tridimensional endoanal ultrasound? Magnetic resonance? Both? Radiol Med 2019; 124:339-349. [PMID: 30607867 DOI: 10.1007/s11547-018-0975-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 12/05/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of the study is to evaluate the diagnostic value of tridimensional endoanal ultrasound (3D-EAUS) and magnetic resonance (MR) in the preoperative assessment of both simple and complex anorectal fistulas. METHODS All the patients referred for the treatment of anal fistulas were enrolled in this study and underwent, as preoperative assessment, anamnestic evaluation, clinical examination, and unenhanced and H2O2-enhanced 3D-EAUS and MR. The results of imaging evaluation were compared with surgical findings, considered as reference standard. RESULTS During the study period, 124 patients operated on for anal fistulas underwent complete preoperative imaging assessment. Perfect agreement between 3D-EAUS and surgery in the anal fistulas' severity grading was found (K = 1). The fistulas were classified as simple in 68/126 (53.9%) and complex in 58/126 (46.03%) cases, according to fistulas' Parks' classification and the most recent American Guidelines. In both simple and complex anal fistulas, 3D-EAUS did not show a significantly higher accuracy in the evaluation of internal openings, if compared with MR (P = 0.47; McNemar's Chi-square test). In the complex anal fistulas, MR showed a significantly higher accuracy in the evaluation of secondary extensions if compared with 3D-EAUS (P = 0.041; McNemar's Chi-square test), whereas in the simple anal fistulas, no significant difference was found. CONCLUSION In the preoperative work-up of patients with anorectal fistulas, 3D-EAUS may represent the first-line diagnostic tool. In cases of fistulas classified as complex by 3D-EAUS, MR may be indicated as adjunctive diagnostic imaging examination, to more carefully describe the fistulas' complete anatomy.
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Affiliation(s)
- Antonio Brillantino
- Department of Surgery, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Francesca Iacobellis
- Department of Radiology, University of Campania "L. Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy.
| | - Alfonso Reginelli
- Department of Radiology, University of Campania "L. Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - Luigi Monaco
- Department of Surgery, "Villa Esther" Hospital, Via Due Principati 169, 83100, Avellino, Italy
| | - Biagio Sodano
- Department of Surgery, "Pellegrini" Hospital, ASL NA1 Centro, via Portamedina alla Pignasecca 41, 80134, Naples, Italy
| | - Giuseppe Tufano
- Department of Surgery, "Pellegrini" Hospital, ASL NA1 Centro, via Portamedina alla Pignasecca 41, 80134, Naples, Italy
| | - Antonio Tufano
- Department of Surgery, "Pellegrini" Hospital, ASL NA1 Centro, via Portamedina alla Pignasecca 41, 80134, Naples, Italy
| | - Mauro Maglio
- Department of Surgery, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Maurizio De Palma
- Department of Surgery, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Natale Di Martino
- Department of Surgery, University of Campania "L. Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - Adolfo Renzi
- "Villa delle Querce" Hospital, Via Battistello Caracciolo 48, 80136, Naples, Italy
| | - Roberto Grassi
- Department of Radiology, University of Campania "L. Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
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Hyde BJ, Byrnes JN, Occhino JA, Sheedy SP, VanBuren WM. MRI review of female pelvic fistulizing disease. J Magn Reson Imaging 2018; 48:1172-1184. [DOI: 10.1002/jmri.26248] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/03/2018] [Accepted: 05/04/2018] [Indexed: 01/14/2023] Open
Affiliation(s)
- Brenda J. Hyde
- Mayo Clinic Department of Radiology; Rochester Minnesota USA
| | - Jenifer N. Byrnes
- Mayo Clinic Department of Obstetrics and Gynecology, Division of Urogynecology; Rochester Minnesota USA
| | - John A. Occhino
- Mayo Clinic Department of Obstetrics and Gynecology, Division of Urogynecology; Rochester Minnesota USA
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13
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Williams G, Williams A, Tozer P, Phillips R, Ahmad A, Jayne D, Maxwell-Armstrong C. The treatment of anal fistula: second ACPGBI Position Statement - 2018. Colorectal Dis 2018; 20 Suppl 3:5-31. [PMID: 30178915 DOI: 10.1111/codi.14054] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 02/16/2018] [Indexed: 02/08/2023]
Abstract
It is over 10 years since the first ACPGBI Position Statement on the management of anal fistula was published in 2007. This second edition is the result of scrutiny of the literature published during this time; it updates the original Position Statement and reviews the published evidence surrounding treatments for anal fistula that have been developed since the original publication.
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Affiliation(s)
- G Williams
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - A Williams
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - P Tozer
- St Mark's Hospital, Harrow, London, UK
| | | | - A Ahmad
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - D Jayne
- University of Leeds, Leeds, UK
| | - C Maxwell-Armstrong
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
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14
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Vernuccio F, Picone D, Midiri F, Salerno S, Lagalla R, Lo Re G. MR Imaging of Perianal Crohn Disease: The Role of Contrast-enhanced Sequences. Radiology 2017; 284:921-922. [DOI: 10.1148/radiol.2017170721] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Federica Vernuccio
- University Hospital “Paolo Giaccone,” Section of Radiology, DIBIMED, University of Palermo, Italy
| | - Dario Picone
- University Hospital “Paolo Giaccone,” Section of Radiology, DIBIMED, University of Palermo, Italy
| | - Federico Midiri
- University Hospital “Paolo Giaccone,” Section of Radiology, DIBIMED, University of Palermo, Italy
| | - Sergio Salerno
- University Hospital “Paolo Giaccone,” Section of Radiology, DIBIMED, University of Palermo, Italy
| | - Roberto Lagalla
- University Hospital “Paolo Giaccone,” Section of Radiology, DIBIMED, University of Palermo, Italy
| | - Giuseppe Lo Re
- University Hospital “Paolo Giaccone,” Section of Radiology, DIBIMED, University of Palermo, Italy
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