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Magnetic Resonance and Traditional Radiology in the Diagnosis of Cryptoglandular Anal Fistula and Abscess

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Anal Fistula and Abscess

Part of the book series: Coloproctology ((COLOPROCT))

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Abstract

Perianal fistula is an inflammatory condition, which refers to an anomalous connection between the anal canal and the skin of the perineum. It usually affects young adults, and it is more common in men than in women. Most anal fistulae are cryptogenic in origin (90.4%); in the other cases, they occur together with predisposing conditions such as pelvic tumors (4.8%), previous pelvic surgery or trauma (3.3%), Crohn’s disease (1.3%), and tuberculosis (0.2%). Infection caused by the obstruction of the anal crypts is the most plausible pathogenic mechanism in cryptogenic perianal fistulas. Offering the lowest resistance pathway, the infection begins in the inter-sphincteric space, where it may spread relatively rapidly into adjacent anatomical compartments. The first radiological exam used to study perianal fistulas was contrast material-enhanced fistulography. This technique was limited by the inability to evaluate the anal sphincter complex, secondary extensions of the fistula, as well as relevant anatomic compartments and muscles. MR imaging is the most accurate method for determining the presence and assessing the course of anal fistulas due to its high soft tissue contrast and multiplanar ability, allowing high accuracy of up to 93%, and it may also help to reduce recurrence after surgery.

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References

  • Abou-Zeid AA (2011) Anal fistula: intraoperative difficulties and unexpected findings. World J Gastroenterol 17:3272–3276

    Article  PubMed  PubMed Central  Google Scholar 

  • Araki Y, Kagawa R, Tomoi M et al (2018) Analysis of deep posterior anal fistulas by magnetic resonance imaging: site of primary abscess and extension patterns according to the primary abscess depth. J Anus Rectum Colon 2:130–138

    Article  PubMed  PubMed Central  Google Scholar 

  • Baik J, Kim SH, Lee Y, Yoon J-H (2017) Comparison of T2-weighted imaging, diffusion-weighted imaging and contrast-enhanced T1-weighted MR imaging for evaluating perianal fistulas. Clin Imaging 44:16–21

    Article  PubMed  Google Scholar 

  • Balcı S, Onur MR, Karaosmanoğlu AD et al (2019) MRI evaluation of anal and perianal diseases. Diagn Interv Radiol 25:21–27

    Article  PubMed  Google Scholar 

  • Baskan O, Koplay M, Sivri M, Erol C (2014) Our experience with MR imaging of perianal fistulas. Pol J Radiol 79:490–497

    Article  PubMed  PubMed Central  Google Scholar 

  • Beets-Tan RG, Beets GL, van der Hoop AG et al (2001) Preoperative MR imaging of anal fistulas: does it really help the surgeon? Radiology 218:75–84

    Article  CAS  PubMed  Google Scholar 

  • Buchanan GN, Halligan S, Bartram CI et al (2004) Clinical examination, endosonography, and MR imaging in preoperative assessment of fistula in ano: comparison with outcome-based reference standard. Radiology 233:674–681

    Article  PubMed  Google Scholar 

  • Cattapan K, Chulroek T, Kordbacheh H et al (2019) Contrast- vs. non-contrast enhanced MR data sets for characterization of perianal fistulas. Abdom Radiol (NY) 44:446–455

    Article  Google Scholar 

  • Cavusoglu M, Duran S, Sözmen Cılız D et al (2017) Added value of diffusion-weighted magnetic resonance imaging for the diagnosis of perianal fistula. Diagn Interv Imaging 98:401–408

    Article  CAS  PubMed  Google Scholar 

  • Chapple KS, Spencer JA, Windsor AC et al (2000) Prognostic value of magnetic resonance imaging in the management of fistula-in-ano. Dis Colon Rectum 43:511–516

    Article  CAS  PubMed  Google Scholar 

  • Chiari H (1878) Uber die analen divertikel der rectumschleimhaut und ihre beziehung zu den anal fisteln. Wien Med Press 19:1482–1483

    Google Scholar 

  • Courtney H (1949) The posterior subsphincteric space; its relation to posterior horseshoe fistula. Surg Gynecol Obstet 89:222–226

    CAS  PubMed  Google Scholar 

  • Day NJ, Earnshaw D, Salazar-Ferrer P, Walsh CJ (2013) Preoperative mapping of fistula-in-ano: a new three-dimensional MRI-based modelling technique. Color Dis 15:e699–e701

    Article  CAS  Google Scholar 

  • de Miguel Criado J, del Salto LG, Rivas PF et al (2012) MR imaging evaluation of perianal fistulas: spectrum of imaging features. Radiographics 32:175–194

    Article  PubMed  Google Scholar 

  • de Parades V, Zeitoun J-D, Atienza P (2010) Cryptoglandular anal fistula. J Visc Surg 147:e203–e215

    Article  PubMed  Google Scholar 

  • Dohan A, Eveno C, Oprea R et al (2014) Diffusion-weighted MR imaging for the diagnosis of abscess complicating fistula-in-ano: preliminary experience. Eur Radiol 24:2906–2915

    Article  PubMed  Google Scholar 

  • Dwarkasing S, Hussain SM, Krestin GP (2005) Magnetic resonance imaging of perianal fistulas. Semin Ultrasound CT MR 26:247–258

    Article  PubMed  Google Scholar 

  • Erden A, Ünal S, Akkaya HE et al (2017) MR Enterography in Crohn’s disease complicated with enteroenteric fistula. Eur J Radiol 94:101–106

    Article  PubMed  Google Scholar 

  • Feng ST, Huang M, Dong Z et al (2019) 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 20:429–437

    Article  PubMed  PubMed Central  Google Scholar 

  • Garcia-Granero A, Granero-Castro P, Frasson M et al (2014) Management of cryptoglandular supralevator abscesses in the magnetic resonance imaging era: a case series. Int J Color Dis 29:1557–1564

    Article  Google Scholar 

  • Garg P (2017) Comparing existing classifications of fistula-in-ano in 440 operated patients: is it time for a new classification? A retrospective cohort study. Int J Surg 42:34–40

    Article  PubMed  Google Scholar 

  • Garg P, Singh P, Kaur B (2017) Magnetic resonance imaging (MRI): operative findings correlation in 229 fistula-in-Ano patients. World J Surg 41:1618–1624

    Article  PubMed  Google Scholar 

  • George U, Sahota A, Rathore S (2011) MRI in evaluation of perianal fistula. J Med Imaging Radiat Oncol 55:391–400

    Article  PubMed  Google Scholar 

  • Gu C, Wang Y, Lai L et al (2019) A comparable method to Gd-contrast enhancement in the preoperative evaluation of anal fistula. Medicine 98:e17807

    Article  PubMed  PubMed Central  Google Scholar 

  • Guniganti P, Lewis S, Rosen A et al (2017) Imaging of acute anorectal conditions with CT and MRI. Abdom Radiol (NY) 42:403–422

    Article  Google Scholar 

  • Halligan S (2020) Magnetic resonance imaging of fistula-in-Ano. Magn Reson Imaging Clin N Am 28:141–151

    Article  PubMed  Google Scholar 

  • Halligan S, Stoker J (2006) Imaging of fistula in ano. Radiology 239:18–33

    Article  PubMed  Google Scholar 

  • Hori M, Oto A, Orrin S et al (2009) Diffusion-weighted MRI: a new tool for the diagnosis of fistula in ano. J Magn Reson Imaging 30:1021–1026

    Article  PubMed  Google Scholar 

  • Jayarajah U, Wickramasinghe DP, Samarasekera DN (2017) Anal incontinence and quality of life following operative treatment of simple cryptoglandular fistula-in-ano: a prospective study. BMC Res Notes 10:572

    Article  PubMed  PubMed Central  Google Scholar 

  • Jordán J, Roig JV, García-Armengol J et al (2010) Risk factors for recurrence and incontinence after anal fistula surgery. Color Dis 12:254–260

    Article  Google Scholar 

  • Khati NJ, Sondel Lewis N, Frazier AA et al (2015) CT of acute perianal abscesses and infected fistulae: a pictorial essay. Emerg Radiol 22:329–335

    Article  PubMed  Google Scholar 

  • Koelbel G, Schmiedl U, Majer MC et al (1989) Diagnosis of fistulae and sinus tracts in patients with Crohn disease: value of MR imaging. AJR Am J Roentgenol 152:999–1003

    Article  CAS  PubMed  Google Scholar 

  • Konan A, Onur MR, Özmen MN (2018) The contribution of preoperative MRI to the surgical management of anal fistulas. Diagn Interv Radiol 24:321–327

    Article  PubMed  PubMed Central  Google Scholar 

  • Kuijpers HC, Schulpen T (1985) Fistulography for fistula-in-ano. Dis Colon Rectum 28:103–104

    Article  CAS  PubMed  Google Scholar 

  • Liang C, Lu Y, Zhao B et al (2014) Imaging of anal fistulas: comparison of computed tomographic fistulography and magnetic resonance imaging. Korean J Radiol 15:712–723

    Article  PubMed  PubMed Central  Google Scholar 

  • Lunniss PJ, Armstrong P, Barker PG et al (1992) Magnetic resonance imaging of anal fistulae. Lancet 340:394–396

    Article  CAS  PubMed  Google Scholar 

  • Machielsen AJHM, Iqbal N, Kimman ML et al (2020) The development of a cryptoglandular Anal Fistula Core Outcome Set (AFCOS): an international Delphi study protocol. United European Gastroenterol J 8:220–226

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Morris J, Spencer JA, Ambrose NS (2000) MR imaging classification of perianal fistulas and its implications for patient management. Radiographics 20:623–635; discussion 635–7

    Article  CAS  PubMed  Google Scholar 

  • Oliveira IS, Kilcoyne A, Price MC, Harisinghani M (2017) MRI features of perianal fistulas: is there a difference between Crohn’s and non-Crohn's patients? Abdom Radiol (NY) 42:1162–1168

    Article  Google Scholar 

  • Oto A, Zhu F, Kulkarni K et al (2009) Evaluation of diffusion-weighted MR imaging for detection of bowel inflammation in patients with Crohn’s disease. Acad Radiol 16:597–603

    Article  PubMed  PubMed Central  Google Scholar 

  • Oussalah A, Laurent V, Bruot O et al (2010) Diffusion-weighted magnetic resonance without bowel preparation for detecting colonic inflammation in inflammatory bowel disease. Gut 59:1056–1065

    Article  PubMed  Google Scholar 

  • Parks AG (1961) Pathogenesis and treatment of fistuila-in-ano. Br Med J 1:463–469

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Sahnan K, Adegbola SO, Tozer PJ et al (2018) Innovation in the imaging perianal fistula: a step towards personalised medicine. Ther Adv Gastroenterol 11:1756284818775060

    Article  Google Scholar 

  • Schaefer O, Lohrmann C, Kreisel W et al (2005) Differentiation of perianal fistulas with digital subtraction magnetic resonance fistulography. Inflamm Bowel Dis 11:383–387

    Article  PubMed  Google Scholar 

  • Sneider EB, Maykel JA (2013) Anal abscess and fistula. Gastroenterol Clin N Am 42:773–784

    Article  Google Scholar 

  • Soker G, Gulek B, Yilmaz C et al (2016) The comparison of CT fistulography and MR imaging of perianal fistulae with surgical findings: a case – control study. Abdom Radiol 41:1474–1483

    Article  Google Scholar 

  • Vanbeckevoort D, Bielen D, Vanslembrouck R, Van Assche G (2014) Magnetic resonance imaging of perianal fistulas. Magn Reson Imaging Clin N Am 22:113–123

    Article  PubMed  Google Scholar 

  • Vo D, Phan C, Nguyen L et al (2019) The role of magnetic resonance imaging in the preoperative evaluation of anal fistulas. Sci Rep 9:17947

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Waniczek D, Adamczyk T, Arendt J, Kluczewska E (2015) Direct MRI fistulography with hydrogen peroxide in patients with recurrent perianal fistulas: a new proposal of extended diagnostics. Med Sci Monit 21:439–445

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Yoshizako T, Kitagaki H (2013) A pictorial review of the impact of adding diffusion-weighted MR imaging to other MR sequences for assessment of anal fistulae. Jpn J Radiol 31:371–376

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radiologia Diagnostica e Interventistica Generale, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy

    Laura Maria Minordi, Luigi Larosa & Riccardo Manfredi

  2. Università Cattolica del Sacro Cuore, Istituto di Radiologia, Rome, Italy

    Antonio Bevere, Giovanni Cimino & Riccardo Manfredi

Authors
  1. Laura Maria Minordi
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  2. Luigi Larosa
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  3. Antonio Bevere
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  4. Giovanni Cimino
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  5. Riccardo Manfredi
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Corresponding author

Correspondence to Laura Maria Minordi .

Editor information

Editors and Affiliations

  1. Proctology Unit Dept. of Medical and Surgical Sciences, Foundation University Hospital “A. Gemelli”, IRCCS, Catholic University, Rome, Italy

    Carlo Ratto

  2. Proctology Unit Dept. of Medical and Surgical Sciences, Foundation University Hospital “A. Gemelli”, IRCCS, Rome, Italy

    Angelo Parello

  3. Proctology Unit Dept. of Medical and Surgical Sciences, Foundation University Hospital “A. Gemelli”, IRCCS, Rome, Italy

    Francesco Litta

  4. Proctology Unit Dept. of Medical and Surgical Sciences, Foundation University Hospital “A. Gemelli”, IRCCS, Rome, Italy

    Veronica De Simone

  5. Proctology Unit Dept. of Medical and Surgical Sciences, Foundation University Hospital “A. Gemelli”, IRCCS, Roma, Italy

    Paola Campennì

Section Editor information

  1. University Hospital “A. Gemelli”, Proctology Unit, Catholic University, Rome, Italy

    Francesco Litta MD

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Minordi, L.M., Larosa, L., Bevere, A., Cimino, G., Manfredi, R. (2022). Magnetic Resonance and Traditional Radiology in the Diagnosis of Cryptoglandular Anal Fistula and Abscess. In: Ratto, C., Parello, A., Litta, F., De Simone, V., Campennì, P. (eds) Anal Fistula and Abscess. Coloproctology. Springer, Cham. https://doi.org/10.1007/978-3-030-76670-2_13

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  • DOI: https://doi.org/10.1007/978-3-030-76670-2_13

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-76669-6

  • Online ISBN: 978-3-030-76670-2

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