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CT imaging with fistulography for perianal fistula: does it really help the surgeon?

  • Author Footnotes
    1 Tel.: +86 13969133169; fax: +86 531 87938550.
    Changhu Liang
    Footnotes
    1 Tel.: +86 13969133169; fax: +86 531 87938550.
    Affiliations
    Shandong Medical Imaging Research Institute, Shandong University, No. 324, Jingwu Road, Jinan 250021, P.R. China
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  • Author Footnotes
    2 Tel.: +86 531 85186748; fax: +86 531 87938550.
    Wanli Jiang
    Footnotes
    2 Tel.: +86 531 85186748; fax: +86 531 87938550.
    Affiliations
    Department of Radiology, Taishan Medical University, Taian, P.R. China
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  • Bin Zhao
    Affiliations
    Shandong Medical Imaging Research Institute, Shandong University, No. 324, Jingwu Road, Jinan 250021, P.R. China
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  • Yan Zhang
    Affiliations
    Shandong Medical Imaging Research Institute, Shandong University, No. 324, Jingwu Road, Jinan 250021, P.R. China
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  • Author Footnotes
    3 Tel.: +86 15053103572; fax: +86 531 82679711.
    Yinglin Du
    Footnotes
    3 Tel.: +86 15053103572; fax: +86 531 82679711.
    Affiliations
    Shandong Provincial Center for Disease Control and Prevention, Public Health Institute 72, Jingshi Road, Jinan, Shandong 250014, P.R. China
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  • Yongchao Lu
    Correspondence
    Corresponding author. Tel.: +86 531 85187547; fax: +86 531 87938911.
    Affiliations
    Traditional Chinese Medicine Department, Provincial Hospital affiliated to Shandong University, No. 324, Jingwu Road, Jinan 250021, P.R. China
    Search for articles by this author
  • Author Footnotes
    1 Tel.: +86 13969133169; fax: +86 531 87938550.
    2 Tel.: +86 531 85186748; fax: +86 531 87938550.
    3 Tel.: +86 15053103572; fax: +86 531 82679711.

      Abstract

      Objective

      To prospectively evaluate the relative accuracy of computed tomography (CT) fistulography for preoperative assessment of fistula in ano.

      Materials and Methods

      Ethical committee approval and informed consent were obtained. A total of 22 patients (15 male and 7 female, age 21–58 years) who were suspected of having fistula in ano underwent preoperative CT fistulography (CTF). The CT images of 0.6 mm were obtained respectively before and after fistulography; contrast-enhanced CT scan was also performed in 22 patients. CTF images were evaluated by two expert radiologists to assess the fistulas in the following respects: (a) the volume-rendered imaging; (b) the extensions of active inflammatory tissue; (c) the internal opening and external opening; (d) the hidden areas of tract or abscess; and (e) the deep abscess adjacent to fistula. CT findings in 18 patients were compared with surgical findings or exam under anesthesia.

      Results

      The CTF findings in 18 cases were basically in accordance with the surgical findings and/or examination findings under anesthesia. Both coronal and transverse planes were useful in assessing the location and direction of tracts or abscesses. Complicated spatial information within the perianal soft tissue about the fistula with secondary ramifications or abscesses can be easily demonstrated to the surgeons. Contrast-enhanced images were useful in assessing the inflammatory lesion activity and infiltrated area.

      Conclusion

      CTF exquisitely depicts the perianal anatomy and shows the fistulous tracks with their associated ramifications, enables selection of the most appropriate surgical treatment, and therefore minimizes all chances of recurrence.

      Keywords

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      References

        • Sahni VA
        • Ahmad R
        • Burling D
        Which method is best for imaging of perianal fistula?.
        Abdom Imaging. 2008; 33: 26-30
        • Law PJ
        • Bartram CI
        Anal endosonography: technique and normal anatomy.
        Gastrointest Radiol. 1989; 14: 349-353
        • Al-Khawari HA
        • Gupta R
        • Sinan TS
        • Prakash B
        • Al-Amer A
        • Al-Bolushi S
        Role of magnetic resonance imaging in the assessment of perianal fistulas.
        Med Princ Pract. 2005; 14: 46-52
        • de Miguel Criado J
        • del Salto LG
        • Rivas PF
        • del Hoyo LF
        • Velasco LG
        • de las Vacas MI
        • Marco Sanz AG
        • Paradela MM
        • Moreno EF
        MR imaging evaluation of perianal fistulas: spectrum of imaging features.
        Radiographics. 2012; 32: 175-194
        • Halligan S
        • Bartram CI
        • Williams AB
        • Tarroni D
        • Cohen CR
        Clinical examination, endosonography, and MR imaging in preoperative assessment of fistula in ano: comparison with outcome-based reference standard.
        Radiology. 2004; 233: 674-681
        • Halligan S
        • Stoker J
        Imaging of fistula in ano.
        Radiology. 2006; 239: 18-33
        • Caliste X
        • Nazir S
        • Goode T
        • Street III, JH
        • Hockstein M
        • McArthur K
        • Trankiem CT
        • Sava JA
        Sensitivity of computed tomography in detection of perirectal abscess.
        Am Surg. 2011; 77: 166-168
        • Flohr T
        • Stierstorfer K
        • Raupach R
        • Ulzheimer S
        • Bruder H
        Performance evaluation of a 64-slice CT system with z-flying focal spot.
        Rofo. 2004; 176: 1803-1810
        • Lichy MP
        • Wietek BM
        • Mugler JP
        • Horger W
        • Menzel MI
        • Anastasiadis A
        • Siegmann K
        • Niemeyer T
        • Königsrainer A
        • Kiefer B
        • Schick F
        • Claussen CD
        • Schlemmer HP
        Magnetic resonance imaging of the body trunk using a single-slab, 3-dimensional, T2-weighted turbo-spin-echo sequence with high sampling efficiency (SPACE) for high spatial resolution imaging: initial clinical experiences.
        Invest Radiol. 2005; 40: 754-760
        • Lunniss PJ
        • Phillips RKS
        Anatomy and function of the anal longitudinal muscle.
        Br J Surg. 1992; 79: 882-884
        • Beets-Tan RG
        • Beets GL
        • van der Hoop AG
        • Kessels AG
        • Vliegen RF
        • Baeten CG
        • van Engelshoven JM
        Preoperative MR imaging of anal fistulas: does it really help the surgeon?.
        Radiology. 2001; 218: 75-84
        • Lifeng Y
        • Liu X
        • Leng S
        • Kofler JM
        • Ramirez-Giraldo JC
        • Qu M
        • Christner J
        • Fletcher JG
        • McCollough CH
        Radiation dose reduction in computed tomography: techniques and future perspective.
        Imaging Med. 2009; 1: 65-84
        • Kalra MK
        • Woisetschläger M
        • Dahlström N
        • Singh S
        • Lindblom M
        • Choy G
        • Quick P
        • Schmidt B
        • Sedlmair M
        • Blake MA
        • Persson A
        Radiation dose reduction with Sinogram Affirmed Iterative Reconstruction technique for abdominal computed tomography.
        J Comput Assist Tomogr. 2012; 36: 339-346
        • Tio TL
        • Muder CJJ
        • Wijers OB
        • Sars PR
        • Tytgat GN
        Endosonography of peri-anal and pericolorectal fistula and/or abscess in Crohn's disease.
        Gastrointest Endosc. 1990; 36: 331-336
        • Guillaumin E
        • Jeffrey Jr., RB
        • Shea WJ
        • Asling CW
        • Goldberg HI
        Perirectal inflammatory disease: CT findings.
        Radiology. 1986; 161: 153-157
        • Fayad LM
        • Carrino JA
        • Fishman EK
        Musculoskeletal infection: role of CT in the emergency department.
        Radiographies. 2007; 27: 1723-1736
        • Xia J
        • Ip HH
        • Samman N
        • Wang D
        • Kot CS
        • Yeung RW
        • Tideman H
        Computer-assisted three-dimensional surgical planning and simulation: 3D virtual osteotomy.
        Int J Oral Maxillofac Surg. 2000; 29: 11-17
        • Proscia N
        • Jaffe TA
        • Neville AM
        • Wang CL
        • Dale BM
        • Merkle EM
        MRI of the pelvis in women: 3D versus 2D T2-weighted technique.
        AJR Am J Roentgenol. 2010; 195: 254-259
        • Kim H
        • Lim JS
        • Choi JY
        • Park J
        • Chung YE
        • Kim MJ
        • Choi E
        • Kim NK
        • Kim KW
        Rectal cancer: comparison of accuracy of local-regional staging with two-and three-dimensional preoperative 3-T MR imaging.
        Radiology. 2010; 254: 485-492
        • Futterer JJ
        • Yakar D
        • Strijk SP
        • Barentsz JO
        Preoperative 3T MR imaging of rectal cancer: local staging accuracy using a two dimensional and three-dimensional T2-weighted turbo spin echo sequence.
        Eur J Radiol. 2008; 65: 66-71
        • Spencer JA
        • Ward J
        • Beckingham IJ
        • Adams C
        • Ambrose NS
        Dynamic contrast-enhanced MR imaging of perianal fistulas.
        AJR Am J Roentgenol. 1996; 167: 735-741
        • Morris J
        • Spencer JA
        • Ambrose NS
        MR imaging classification of perianal fistulas and its implications for patient management.
        RadioGraphics. 2000; 20 ([discussion 635–637]): 623-635
        • Bartram C
        • Buchanan G
        Imaging anal fistula.
        Radiol Clin North Am. 2003; 41: 443-457
        • Yousem DM
        • Fishman EK
        • Jones B
        Crohn disease: perirectal and perianal findings at CT.
        Radiology. 1998; 167: 331-334
        • Tang CL
        • Chew SP
        • Seow-Choen F
        Prospective randomized trial of drainage alone vs. drainage and fistulotomy for acute perianal abscesses with proven internal opening.
        Dis Colon Rectum. 1996; 39: 1415-1417
        • Spencer JA
        • Chapple K
        • Wilson D
        • Ward J
        • Windsor AC
        • Ambrose NS
        Outcome after surgery for perianal fistula: predictive value of MR imaging.
        AJR Am J Roentgenol. 1998; 171: 403-406
        • Chapple KS
        • Spencer JA
        • Windsor AC
        • Wilson D
        • Ward J
        • Ambrose NS
        Prognostic value of magnetic resonance imaging in the management of fistula-in-ano.
        Dis Colon Rectum. 2000; 43: 511-516
        • Harisinghani MG
        • Gervais DA
        • Hahn PF
        • Cho CH
        • Jhaveri K
        • Varghese J
        • Mueller PR
        CT-guided transgluteal drainage of deep pelvic abscesses: indications, technique, procedure-related complications, and clinical outcome.
        Radiographics. 2002; 22: 1353-1367