Radiology Department, Hillcrest Hospital, University of California San Diego, San Diego, USA.
Radiology Department, Loghman Hakim Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran.
J Ultrasound Med. 2023 Sep;42(9):2057-2064. doi: 10.1002/jum.16225. Epub 2023 Apr 11.
Perianal fistula is a common disorder characterized by an anomalous perianal track connecting two epithelialized surfaces, most commonly the anal canal and the perianal skin. Although each has its limitations, magnetic resonance imaging (MRI) and endoanal ultrasound are currently two acceptable modalities for assessing perianal fistula. This study aimed to evaluate the accuracy of MRI and endoanal ultrasonography in diagosing perianal fistula, considering the surgical results as the references.
This prospective cohort study was performed on patients with symptomatic perianal fistulas. MRI results of patients reported by the radiologist were collected along with the findings of endoanal ultrasonography performed by a gastroenterologist. These results were compared with surgical findings as the reference standard.
The study enrolled 126 patients. Exactly 222 definitive fistulas were identified during surgery. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ultrasound for perianal fistula were 87.38, 38.46, 92.38, 26.31, and 82.25% respectively; and for MRI were 76.12, 57.69, 93.88, 22.05, and 74.19% respectively. The accuracy of endoanal ultrasound for detecting transsphincteric and intersphincteric fistulas was higher than MRI. In contrast, the diagnostic value of MRI for detecting suprasphincteric fistulas was higher than endoanal ultrasound.
Using endoanal ultrasonography to diagnose perianal fistulas is a relatively accurate method. This method may be more sensitive than MRI in detecting patients with perianal fistulas and abscesses.
肛周瘘是一种常见的疾病，其特征是异常的肛周通道连接两个上皮化表面，最常见的是肛管和肛周皮肤。尽管每种方法都有其局限性，但磁共振成像（MRI）和经肛门超声目前是评估肛周瘘的两种可接受的方法。本研究旨在评估 MRI 和经肛门超声在诊断肛周瘘方面的准确性，以手术结果为参考。
这项前瞻性队列研究纳入了有症状的肛周瘘患者。收集放射科医生报告的患者的 MRI 结果和胃肠病学家进行的经肛门超声检查结果。这些结果与手术结果作为参考标准进行比较。
研究共纳入 126 例患者。手术中总共确定了 222 个明确的瘘管。超声对肛周瘘的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为 87.38%、38.46%、92.38%、26.31%和 82.25%；MRI 分别为 76.12%、57.69%、93.88%、22.05%和 74.19%。经肛门超声对检测穿通性和括约肌间瘘的准确性高于 MRI。相比之下，MRI 对检测高位瘘的诊断价值高于经肛门超声。
使用经肛门超声诊断肛周瘘是一种相对准确的方法。与 MRI 相比，该方法在检测肛周瘘和脓肿患者时可能更敏感。
