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Ren J, Bai W, Gu L, Li X, Peng X, Li W. Three-dimensional pelvic ultrasound is a practical tool for the assessment of anal fistula. BMC Gastroenterol 2023; 23:134. [PMID: 37098484 PMCID: PMC10127404 DOI: 10.1186/s12876-023-02715-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/09/2023] [Indexed: 04/27/2023] Open
Abstract
OBJECTIVE This study aims to investigate the diagnostic value of three-dimensional pelvic ultrasound in the preoperative assessment of anal fistula compared with findings of MRI and surgery. METHODS A total of 67 patients (62 males) with suspected anal fistula were analyzed retrospectively. Preoperative three-dimensional pelvic ultrasound and magnetic resonance imaging were performed in all patients. The number of internal openings and the type of fistula were recorded. The accuracy of three-dimensional pelvic ultrasound was determined by comparing these parameters with surgical outcomes. RESULTS At surgery, 5 (6%) were extrasphincteric, 10 (12%) were suprasphincteric, 11 (14%) were intersphincteric, and 55 (68%) were transsphincteric. There was no significant difference in the accuracy of pelvic 3D US and MRI, based on internal openings (97.92%, 94.79%), anal fistulas (97.01%, 94.03%), and those under Parks classification (97.53%, 93.83%). CONCLUSION Three-dimensional pelvic ultrasound is a reproducible and accurate method for determining the type of fistula and detecting internal openings and anal fistulas.
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Affiliation(s)
- Junyi Ren
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6Th People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Wenkun Bai
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6Th People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6Th People's Hospital, Shanghai, China
| | - Liangrui Gu
- Department of Radiology in Medicine, Shanghai Jiao Tong University Affiliated 6Th People's Hospital, Shanghai, China
| | - Xiao Li
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6Th People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Xue Peng
- Department of Breast Surgery, Shanghai Jiao Tong University Affiliated 6Th People's Hospital, Shanghai, China
| | - WeiMei Li
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6Th People's Hospital, Shanghai, China.
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Gou B, Zhang JC, Chen L, Xin FY, Zhou JY, Xu QM, Liu J. Comparison of the Diagnostic Accuracy of Percutaneous Fistula Contrast-Enhanced Ultrasound Combined with Transrectal 360° 3-D Imaging and Conventional Transrectal Ultrasound in Complex Anal Fistula. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:2154-2161. [PMID: 35948456 DOI: 10.1016/j.ultrasmedbio.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 06/15/2023]
Abstract
This study compared the diagnostic accuracy of percutaneous fistula contrast-enhanced ultrasound (CEUS) combined with 360° 3-D transrectal ultrasound (TRUS) imaging (CEUS + 360°-TRUS) with that of conventional transrectal ultrasound in the diagnosis of complex anal fistulas. A total of 156 patients clinically diagnosed with complex anal fistula from January 2020 to December 2021 were studied and randomly divided into an experimental group (n = 82) and a control group (n = 74). Patients in the experimental group were examined by percutaneous fistula CEUS combined with CEUS + 360°-TRUS, while patients in the control group were examined using TRUS. The detection of fistulas (main tract, branch and internal orifice) and the accuracy of Parks classification were compared between the two groups. Recurrences were followed up at 1, 3 and 6 mo after the surgery. A total of 156 patients were included, aged 23-68 y (average: 37.7 ± 18.2 y). In both groups, the course of disease was <1 mo in 128 cases, 1-2 mo in 22 cases and >3 mo in 6 cases. A total of 474 fistulas were confirmed by surgery in the aforementioned patients, including 224 main fistulas, 250 branch pipes and 254 internal orifices. The CEUS + 360°-TRUS group had 96.87%, 90.41% and 90.14% diagnostic accuracy for the main tract, branch and internal orifice, which was statistically significant (p < 0.001) compared with the 85.00%, 70.00% and 72.46% for the TRUS group, respectively. The overall accuracy of Parks classification of anal fistula in the CEUS + 360°-TRUS group was significantly higher than that in the TRUS group (90.24% vs. 78.38%, p < 0.001). After 6 mo of follow-up, the recurrence rate in the CEUS + 360°-TRUS group was 4.87%, and the recurrence rate in the TRUS group was 18.91%. Percutaneous fistula CEUS combined with transrectal 360° 3-D imaging has significantly higher accuracy than conventional TRUS in the diagnosis of complex anal fistula, especially for anal fistula branches, internal openings and Parks classification and is beneficial in reducing post-operative occurrence of complex anal fistulas.
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Affiliation(s)
- Bo Gou
- Department of Ultrasound, Clinical Medical College, Chengdu, China; First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Ji-Cheng Zhang
- Department of Ultrasound, Clinical Medical College, Chengdu, China; First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Lin Chen
- First Affiliated Hospital of Chengdu Medical College, Chengdu, China; Traditional Chinese and Western Medicine Anorectal, Clinical Medical College, Chengdu, China
| | - Feng-Yue Xin
- Department of Ultrasound, Clinical Medical College, Chengdu, China; First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Jiang-Ying Zhou
- Department of Ultrasound, Clinical Medical College, Chengdu, China; First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Qin-Mei Xu
- Department of Ultrasound, Clinical Medical College, Chengdu, China; First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Jian Liu
- Department of Ultrasound, Clinical Medical College, Chengdu, China; First Affiliated Hospital of Chengdu Medical College, Chengdu, China.
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Du X, Yan Y, Sun P, Yang S, Pan Z, Liu S, Jiang T. Value of CT sinography and analysis of missed diagnosis and misdiagnosis for abdominal wall sinus. BMC Gastroenterol 2022; 22:214. [PMID: 35505325 PMCID: PMC9063235 DOI: 10.1186/s12876-022-02291-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/20/2022] [Indexed: 11/20/2022] Open
Abstract
Background The value of CT (computed tomography) sinography in evaluating abdominal wall sinus tracts is currently unclear. The present study aims to investigate the accuracy of CT sinography in diagnosing the extent of abdominal sinus and analyze the reasons for misdiagnosis. Materials and methods 64 patients with abdominal sinus tract formation (including fistula) undergoing CT sinography in our hospital from January 2018 to November 2020 were retrospectively analyzed. The CT images were blindly and independently re-assessed by two radiologists with 5- and 18-years work experience, respectively. Whether the sinus tract was confined to the abdominal wall or had invaded the abdominal cavity, and whether there was fistula formation were evaluated. The accuracy of CT sinography in diagnosing sinus invasion in the abdominal cavity and fistula formation was calculated. The agreements of CT sinography-surgical results and inter-observer were assessed using weighted-kappa statistics. Results The weighted- Kappa of inter-observer agreement (0.825, P < 0.001) and CT sinography—surgical results (0.828, P < 0.001) were both perfect. The diagnostic accuracy, sensibility, and specificity of sinus tract confined to the abdominal wall were 90.6% (95% CI: 80.7–96.5), 85.7% (95% CI: 67.3–96.0), and 94.4% (95% CI: 81.3–99.3), respectively. The diagnostic accuracy, sensibility, and specificity of fistula formation were 93.8% (95% CI: 84.8–98.3), 89.5% (95% CI: 66.9–98.7), and 95.6% (95% CI: 84.9–99.5), respectively. A total of 4 cases of sinus tract confined to the abdominal wall were misdiagnosed as invading the abdominal cavity, 2 cases of sinus tract invading the abdominal cavity were misdiagnosed as confined to the abdominal wall, 2 cases of enterocutaneous fistula were missed, 1 case of enterocutaneous fistula was misdiagnosed, 1 case of vesico-cutaneous fistula was misdiagnosed, and no cases of vesico-cutaneous fistula were missed. Conclusions CT sinography can accurately assess the extent of an abdominal sinus tract and reveal fistula formation, despite some inevitable misdiagnosis and missed diagnosis. Radiologists should find more clues to improve the diagnostic accuracy.
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Affiliation(s)
- Xuechao Du
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100043, China
| | - Yuchang Yan
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100043, China
| | - Pengtao Sun
- Department of Radiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Shuo Yang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, China
| | - Zhenyu Pan
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100043, China
| | - Sujun Liu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, China
| | - Tao Jiang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100043, China.
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Perianal fistulas: A review with emphasis on preoperative imaging. Adv Med Sci 2022; 67:114-122. [PMID: 35134600 DOI: 10.1016/j.advms.2022.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/24/2021] [Accepted: 01/14/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE We aim to present a comprehensive literature review which focuses on the preoperative imaging of perianal fistulas. MATERIAL/METHODS Pelvic magnetic resonance imaging (MRI) and endoanal ultrasound (EAUS) are the two first-line imaging modalities for the preoperative evaluation of patients with perianal fistulas. We conducted a search in PubMed, Scopus and Google Scholar concerning articles comparing pelvic MRI with EAUS, which were published from 1994 until 2019. RESULTS In most articles, pelvic MRI is superior to EAUS for the evaluation of perianal fistulas (especially for supralevator and extrasphincteric ones). Preoperative pelvic MRI is associated with statistically significant better results and prognosis after surgical treatment of the disease. Preoperative EAUS poses high sensitivity and specificity in identifying intersphincteric and transsphincteric perianal fistulas, as well as the internal opening of a fistula-in-ano. There is only one meta-analysis which compares the diagnostic accuracy of the two mentioned imaging modalities in preoperative fistula detection. Sensitivity of both - pelvic MRI and EAUS, is acceptably high (0.87). Specificity of pelvic MRI is 0.69 in comparison to EAUS (0.43), but both values are considered low. CONCLUSIONS Future well-designed prospective studies are needed to investigate the diagnostic accuracy of pelvic MRI and EAUS in the preoperative assessment of patients with perianal fistulas. Moreover, the combination of pelvic MRI and EAUS should also be studied, since several published articles suggest that it could lead to improved diagnostic accuracy. A novel treatment algorithm for perianal fistulas could arise from this study.
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Deep Learning-Based CT Image Characteristics and Postoperative Anal Function Restoration for Patients with Complex Anal Fistula. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:1730158. [PMID: 34367532 PMCID: PMC8337139 DOI: 10.1155/2021/1730158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/24/2021] [Accepted: 07/07/2021] [Indexed: 12/23/2022]
Abstract
Objective This study aimed to optimize the CT images of anal fistula patients using a convolutional neural network (CNN) algorithm to investigate the anal function recovery. Methods 57 patients with complex anal fistulas admitted to our hospital from January 2020 to February 2021 were selected as research subjects. Of them, CT images of 34 cases were processed using the deep learning neural network, defined as the experimental group, and the remaining unprocessed 23 cases were in the control group. Whether to process CT images depended on the patient's own wish. The imaging results were compared with the results observed during the surgery. Results It was found that, in the experimental group, the images were clearer, with DSC = 0.89, precision = 0.98, and recall = 0.87, indicating that the processing effects were good; that the CT imaging results in the experimental group were more consistent with those observed during the surgery, and the difference was notable (P < 0.05). Furthermore, the experimental group had lower RP (mmHg), AMCP (mmHg) scores, and postoperative recurrence rate, with notable differences noted (P < 0.05). Conclusion CT images processed by deep learning are clearer, leading to higher accuracy of preoperative diagnosis, which is suggested in clinics.
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Waheed KB, Shah WJ, Altaf B, Amjad M, Hameed F, Wasim S, UlHassan MZ, Abuabdullah ZM, Rajamonickam SN, Arulanatham ZJ. Magnetic resonance imaging findings in patients with initial manifestations of perianal fistulas. Ann Saudi Med 2020; 40:42-48. [PMID: 32026703 PMCID: PMC7012033 DOI: 10.5144/0256-4947.2020.42] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Crohn's disease (CD) is a serious cause of perianal disease and the incidence is increasing in Saudi Arabia. MR imaging may document specific features that may help to foresee Crohn's disease in patients making an initial presentation. OBJECTIVE Present MR imaging findings of perianal fistulas in patients making an initial presentation. DESIGN Retrospective, observational. SETTING Radiology clinic in in Dhahran. PATIENTS AND METHODS All previously undiagnosed and untreated patients who presented for the first time to the outpatient clinics from September 2015-2018 with perianal fistulas were retrospectively evaluated. Previously diagnosed CD patients, post-surgical or intervention cases were excluded. Fistulas were categorized as low or high anal, simple or complex, and were graded per St. James University Hospital Classification. Imaging was interpreted by two experienced readers based on the Van Assche score. MAIN OUTCOME MEASURES Fistula features on MR imaging and diagnosis of CD. SAMPLE SIZE 171 patients. RESULTS Of 171 patients, 139 (81.3%) were males with mean age of 37.2 (12.7) years; the 32 females had a mean age of 35.8 (10.6) years. Twenty-one patients (12.3%) had CD. Fourteen (40.4%) patients with complex fistulas had CD in comparison to only 5 (4.8%) simple fistula patients ( P=.0005). More than half of patients with complex and high anal fistulas had CD ( P=.0005). Females were more affected than males ( P=.0005). CONCLUSION Complex or high anal fistula on MR imaging may be the initial presentation of CD and warrant further work up to establish the diagnosis. LIMITATIONS Retrospective, small sample, single center, and short duration study. CONFLICT OF INTEREST None.
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Affiliation(s)
- Khawaja Bilal Waheed
- From the Department of Radiology, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Waseem Jan Shah
- From the Department of Pediatric Surgery, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Bilal Altaf
- From the Department of General Surgery, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Muhammad Amjad
- From the Department of Internal Medicine, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Fawad Hameed
- From the Department of General Surgery, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Sana Wasim
- From the Department of Radiology, Rawalpindi Medical College, Rawalpindi, Pakistan
| | - Muhammad Zia UlHassan
- From the Department of Radiology, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
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Adipose-Derived Stem Cells Are an Efficient Treatment for Fistula-in-ano of Japanese Rabbit. Stem Cells Int 2019; 2019:6918090. [PMID: 31781244 PMCID: PMC6855042 DOI: 10.1155/2019/6918090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/08/2019] [Accepted: 07/25/2019] [Indexed: 02/06/2023] Open
Abstract
Fistula-in-ano (FIA, anal fistula) treatment remains a surgical challenge for coloproctologists. Adipose tissue-derived stem cells (ADSCs) are a new frontier in the treatment of FIA. In this study, we established a FIA model of Japanese rabbit and evaluated the effect of four treatments on fistula healing: ADSC transplantation, acellular small intestinal submucosa (ASIS), noncutting seton, and PBS as negative control. High-throughput RNA sequencing was also performed to investigate the anal tissue (normal and ADSC treatment group) expression profile of mRNA. Our data showed that ADSC treatment had the shortest time to promote fistula healing compared to the other treatments, and fistula filled with new adipose tissue and muscle cells without scar. Gene Ontology (GO) analysis of RNA-seq data showed that the differential genes are enriched in system development and animal organ development. Taken together, our findings demonstrate that ADSCs rapidly promote fistula healing through differentiation, a promising stem cell therapy for FIA. The rabbit is an effective animal model for evaluating FIA therapeutic options.
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