Chauhan Narvir Singh, Sood Dinesh, Shukla Anurag
Department of Radiology, Dr. Rajendra Prasad Government Medical College - Tanda, Kangra, Himachal Pradesh, India.
Pol J Radiol. 2016 Dec 22;81:611-617. doi: 10.12659/PJR.899315. eCollection 2016.
To diagnose and characterize the perianal fistulous disease using Magnetic resonance imaging (MRI) in a hilly and rural area of North India.
MATERIAL/METHODS: This prospective hospital based study was conducted for a period of one year from April 2014 to April 2015 in the departments of Radiodiagnosis and Surgery of our institute. A total of 50 consecutive patients presenting with perianal fistulous disease fulfilling the inclusion and exclusion criteria were included in the study and taken up for MRI. The perianal fistulae were classified according to St James University hospital classification and tracks were assessed with regard to anatomical plane, length, ramifications, abscess formation, enteric communication, external cutaneous opening, enhancement and suprasphincteric extension. Surgical correlation was done in 31 patients who opted for surgical treatment. Rest of the 19 patients preferred alternative medicine for treatment or chose to postpone their surgery.
The disease was much more prevalent in males in comparison to females with male to female ratio of 24:1. Grade 4 was the most common type of fistula (34%) while Grade 5 was the least common type (4%).MRI showed a high sensitivity of 93.7% and positive predictive value (PPV) of 96.7% when correlated with surgical findings. A substantial number of patients (38%) preferred alternative medicine or non surgical form of treatment.
MRI is a very sensitive modality for the evaluation of perianal fistula. In our study group, the disease predominantly affected middle aged men. Ramifications and abscesses were commonly seen, affecting nearly half of the patients and majority of the patients had active fistulous tracks with posteriorly located enteric opening. Overall, transsphincteric fistulae were most common. Significant number of patients avoided surgery or showed preference for non surgical treatment.
在印度北部一个多山的农村地区，使用磁共振成像（MRI）对肛周瘘管病进行诊断和特征描述。
材料/方法：本前瞻性医院研究于2014年4月至2015年4月在我院放射诊断科和外科进行，为期一年。共有50例符合纳入和排除标准的肛周瘘管病患者纳入研究并接受MRI检查。肛周瘘管根据圣詹姆斯大学医院分类法进行分类，并对瘘管在解剖平面、长度、分支、脓肿形成、肠内沟通、外皮肤开口、强化及括约肌上延伸情况进行评估。对31例选择手术治疗的患者进行了手术相关性分析。其余19例患者选择替代医学治疗或选择推迟手术。
与女性相比，该疾病在男性中更为普遍，男女比例为24:1。4级是最常见的瘘管类型（34%），而5级是最不常见的类型（4%）。与手术结果相关时，MRI显示出93.7%的高敏感性和96.7%的阳性预测值（PPV）。相当数量的患者（38%）选择替代医学或非手术治疗方式。
MRI是评估肛周瘘管的一种非常敏感的检查方法。在我们的研究组中，该疾病主要影响中年男性。常见分支和脓肿，近一半患者受影响，大多数患者有活跃的瘘管，肠内开口位于后方。总体而言，经括约肌瘘最为常见。相当数量的患者避免手术或倾向于非手术治疗。
