Preoperative assessment of simple and complex anorectal fistulas: Tridimensional endoanal ultrasound? Magnetic resonance? Both? View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2019-01-03

AUTHORS

Antonio Brillantino, Francesca Iacobellis, Alfonso Reginelli, Luigi Monaco, Biagio Sodano, Giuseppe Tufano, Antonio Tufano, Mauro Maglio, Maurizio De Palma, Natale Di Martino, Adolfo Renzi, Roberto Grassi

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. More... »

PAGES

1-11

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  • Journal

    TITLE

    La radiologia medica

    ISSUE

    N/A

    VOLUME

    N/A

    Author Affiliations

    Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s11547-018-0975-3

    DOI

    http://dx.doi.org/10.1007/s11547-018-0975-3

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1111058328

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/30607867


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