Basavaraju Umamaheshwari K, Ravate Patil Shivani S, Manupratap N, Tejesh B, Shamasundara Shubha Tavarakere, Reuben Larryth
Department of Radiodiagnosis, Mysore Medical College and Research Institute, Mysore, India.
SA J Radiol. 2025 Aug 15;29(1):3166. doi: 10.4102/sajr.v29i1.3166. eCollection 2025.
Magnetic resonance fistulography (MRF) is a key non-invasive imaging technique for mapping perianal fistulas before surgery. The instillation of aqueous jelly, like ultrasound gel, enhances the signal-to-noise ratio, improving image quality and MRF accuracy. This low-cost approach improves accessibility, especially in resource-limited settings, while ensuring patient comfort and safety.
To determine the impact of aqueous jelly on the accuracy of MRF in identifying fistulous tracts, internal openings, secondary ramifications and abscesses and the quality of visualisation of MRF with and without jelly instillation.
A cross-sectional study at Krishna Rajendra and Cheluvamba Hospitals, Mysore (October 2024-March 2025), included 40 patients with perianal fistulas. Magnetic resonance fistulography was performed using a 1.5 Tesla uMR 570 system, without and with 5 mL - 7 mL of sterile aqueous jelly instilled percutaneously. MRI findings were compared with intraoperative results. Data were analysed using Statistical Package for the Social Sciences (SPSS) to assess sensitivity, specificity and accuracy.
Magnetic resonance fistulography with gel improved visualisation, identifying internal openings in 92.5% of cases (vs. 24% without gel) and secondary tracts in 40% (vs. 17.5%). The accuracy compared to surgery was 97.5% for internal openings, 95% for secondary tracts, 97.5% for abscesses and 100% for supralevator extension.
Aqueous jelly instillation enhances MRF accuracy, improving fistula visualisation and aiding in preoperative planning. This technique reduces recurrence and incontinence risk and supports more accurate surgical interventions.
This study re-emphasises the value of aqueous jelly in improving diagnostic accuracy and accessibility, especially in resource-limited settings.
磁共振瘘管造影（MRF）是术前对肛周瘘管进行 mapping 的关键非侵入性成像技术。与超声凝胶一样，注入水性凝胶可提高信噪比，改善图像质量和 MRF 准确性。这种低成本方法提高了可及性，尤其是在资源有限的环境中，同时确保了患者的舒适度和安全性。
确定水性凝胶对 MRF 在识别瘘管、内口、分支和脓肿方面的准确性以及有无凝胶注入时 MRF 的可视化质量的影响。
在迈索尔的克里希纳·拉金德拉医院和切卢万巴医院进行的一项横断面研究（2024 年 10 月至 2025 年 3 月）纳入了 40 例肛周瘘管患者。使用 1.5 特斯拉 uMR 570 系统进行磁共振瘘管造影，分别在不注入和经皮注入 5 mL - 7 mL 无菌水性凝胶的情况下进行。将 MRI 结果与术中结果进行比较。使用社会科学统计软件包（SPSS）分析数据，以评估敏感性、特异性和准确性。
使用凝胶的磁共振瘘管造影改善了可视化，在 92.5%的病例中识别出内口（无凝胶时为 24%），在 40%的病例中识别出分支（无凝胶时为 17.5%）。与手术相比，内口的准确性为 97.5%，分支为 95%，脓肿为 97.5%，肛提肌上扩展为 100%。
注入水性凝胶可提高 MRF 准确性，改善瘘管可视化并有助于术前规划。该技术降低了复发和失禁风险，并支持更准确的手术干预。
本研究再次强调了水性凝胶在提高诊断准确性和可及性方面的价值，尤其是在资源有限的环境中。
