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

  • ABDOMINAL RADIOLOGY
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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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Abbreviations

3D-EAUS:

Tridimensional endoanal ultrasound

MR:

Magnetic resonance

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Author notes

  1. Antonio Brillantino and Francesca Iacobellis have contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131, Naples, Italy

    Antonio Brillantino, Mauro Maglio & Maurizio De Palma

  2. Department of Radiology, University of Campania “L. Vanvitelli”, Piazza Miraglia 2, 80138, Naples, Italy

    Francesca Iacobellis, Alfonso Reginelli & Roberto Grassi

  3. Department of Surgery, “Villa Esther” Hospital, Via Due Principati 169, 83100, Avellino, Italy

    Luigi Monaco

  4. Department of Surgery, “Pellegrini” Hospital, ASL NA1 Centro, via Portamedina alla Pignasecca 41, 80134, Naples, Italy

    Biagio Sodano, Giuseppe Tufano & Antonio Tufano

  5. Department of Surgery, University of Campania “L. Vanvitelli”, Piazza Miraglia 2, 80138, Naples, Italy

    Natale Di Martino

  6. “Villa delle Querce” Hospital, Via Battistello Caracciolo 48, 80136, Naples, Italy

    Adolfo Renzi

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  1. Antonio Brillantino
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Correspondence to Francesca Iacobellis.

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The authors declare that they have no conflict of interest.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Brillantino, A., Iacobellis, F., Reginelli, A. et al. Preoperative assessment of simple and complex anorectal fistulas: Tridimensional endoanal ultrasound? Magnetic resonance? Both?. Radiol med 124, 339–349 (2019). https://doi.org/10.1007/s11547-018-0975-3

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  • DOI: https://doi.org/10.1007/s11547-018-0975-3

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