Skip to main content

Advertisement

SpringerLink
Log in

MRI of anal canal: normal anatomy, imaging protocol, and perianal fistulas: Part 1

  • Pictorial essay
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Anal complaints are very common in the general population and are caused by a variety of disorders mostly benign in nature. The aim of this article is to provide the radiologist with a detailed description of the MRI anatomy and technique, and an overview of the various diseases most commonly presenting with anal pain, by descriptions and illustrative examples of MRI features of each entity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18
Fig. 19
Fig. 20
Fig. 21
Fig. 22
Fig. 23
Fig. 24
Fig. 25
Fig. 26
Fig. 27
Fig. 28
Fig. 29
Fig. 30
Fig. 31
Fig. 32

Similar content being viewed by others

References

  1. Lunniss PJ (2016) Chapter: 66 Large intestine. In: Standring S (ed) Gray’s anatomy: the anatomical basis of clinical practice, 41st edn. London: Elsevier Churchill Livingstone, pp 1155–1158

    Google Scholar 

  2. Krieglstein CF (2008) Surgical procedures for perianal sepsis: ıschiorectal abscesses, fistulas, and pilonidal sinus. In: Thomas WEG, Senninger N (eds). Short Stay Surgery. Chapter 15, Springer, Berlin, pp. 295–308

  3. Agur AMR, Lee MJ, Grant JCB (1999) Grant’s atlas of anatomy, 10th edn. London: Lippincott Williams and Wilkins

    Google Scholar 

  4. Salerno G, Sinnatambi C, Branagan G, et al. (2006) Defining the rectum: surgically, radiologically and anatomically. Colorectal Dis 8:5–9

    Article  PubMed  Google Scholar 

  5. Erden A, Peker E, Gençtürk ZB (2017) Chronic anal fissure: morphometric analysis of the anal canal at 3.0 Tesla MR imaging. Abdom Radiol (NY) 42:423–434

    Article  Google Scholar 

  6. Al-Ali S, Blyth P, Beatty S, et al. (2009) Correlation between gross anatomical topography, sectional sheet plastination, microscopic anatomy and endoanal sonography of the anal sphincter complex in human males. J Anat 215:212–220

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Beets-Tan RG, Morren GL, Beets GL, et al. (2001) Measurement of anal sphincter muscles: endoanal US, endoanal MR imaging, or phased-array MR imaging? A study with healthy volunteers. Radiology 220:81–89

    Article  CAS  PubMed  Google Scholar 

  8. Rociu E, Stoker J, Eijkemans MJ, Laméris JS (2000) Normal anal sphincter anatomy and age- and sex-related variations at high-spatial-resolution endoanal MR imaging. Radiology 217:395–401

    Article  CAS  PubMed  Google Scholar 

  9. Huebner M, Margulies RU, Fenner DE, et al. (2007) Age effects on internal anal sphincter thickness and diameter in nulliparous females. Dis Colon Rectum 50:1405–1411

    Article  PubMed  PubMed Central  Google Scholar 

  10. Lewicky-Gaupp C, Hamilton Q, Ashton-Miller J, et al. (2009) Anal sphincter structure and function relationships in aging and fecal incontinence. Am J Obstet Gynecol 200(559):e1

    Google Scholar 

  11. Klosterhalfen B, Offner F, Topf N, Vogel P, Mittermayer C (1990) Sclerosis of the internal anal sphincter-a process of aging. Dis Colon Rectum 33:606–609

    Article  CAS  PubMed  Google Scholar 

  12. Federative Committee on Anatomical Terminology (1998) Muscles; muscular system. In: Terminologia anatomica: international anatomical terminology. Georg Thieme Verlag, Stuttgart, pp. 39–40

  13. Wasserman IF (1964) Puborectalis syndrome (rectal stenosis due to anorectal spasm). Dis Colon Rectum 7:87–98

    Article  CAS  PubMed  Google Scholar 

  14. Macchi V, Porzionato A, Stecco C, et al. (2008) Histo-topographic study of the longitudinal anal muscle. Clin Anat 21:447–452

    Article  PubMed  Google Scholar 

  15. Skandalakis JE, Colborn GL (2004) Chapter 18. Large intestine and anorectum. In: Skandalakis’ surgical anatomy: the embryologic and anatomic basis of modern surgery, 1st edn. Athens: Paschalidis Medical Publications

    Google Scholar 

  16. Colaiacomo MC, Masselli G, Polettini E, et al. (2009) Dynamic MR imaging of the pelvic floor: a pictorial review. Radiographics 29:e35

    Article  PubMed  Google Scholar 

  17. Goh V, Halligan S, Kaplan G, Healy JC, Bartram CI (2000) Dynamic MR imaging of the pelvic floor in asymptomatic subjects. AJR Am J Roentgenol 174:661–666

    Article  CAS  PubMed  Google Scholar 

  18. Schreyer AG, Paetzel C, Fürst A, et al. (2012) Dynamic magnetic resonance defecography in 10 asymptomatic volunteers. World J Gastroenterol 18:6836–6842

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kinugasa Y, Arakawa T, Abe S, et al. (2011) Anatomical reevaluation of the anococcygeal ligament and its surgical relevance. Dis Colon Rectum 54:232–237

    Article  PubMed  Google Scholar 

  20. Santoro GA, Shobeiri SA, Petros PP, Zapater P, Wieczorek AP (2016) Perineal body anatomy seen by three-dimensional endovaginal ultrasound of asymptomatic nulliparae. Colorectal Dis 18:400–409

    Article  CAS  PubMed  Google Scholar 

  21. Shafik A, Sibai OE, Shafik AA, Shafik IA (2007) A novel concept for the surgical anatomy of the perineal body. Dis Colon Rectum 50:2120–2125

    Article  PubMed  Google Scholar 

  22. Lunniss PJ, Armstrong P, Barker PG, et al. (1992) Magnetic resonance imaging of anal fistulae. Lancet 340:394–396

    Article  CAS  PubMed  Google Scholar 

  23. Spencer JA, Chapple K, Wilson D, et al. (1998) Outcome after surgery for perianal fistula: predictive value of MR imaging. AJR Am J Roentgenol 171:403–406

    Article  CAS  PubMed  Google Scholar 

  24. Glynne-Jones R, Northover JM, Cervantes A (2010) ESMO guidelines working group. Anal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 21:87–92

    Article  Google Scholar 

  25. Brown G, Daniels IR, Richardson C, et al. (2005) Techniques and trouble-shooting in high spatial resolution thin slice MRI for rectal cancer. Br J Radiol 78:245–251

    Article  CAS  PubMed  Google Scholar 

  26. Halligan S, Stoker J (2006) Imaging of fistula in ano. Radiology 239:18–33

    Article  PubMed  Google Scholar 

  27. Parks AG, Gordon PH, Hardcastle JD (1976) A classification of fistula-in-ano. Br J Surg 63:1–12

    Article  CAS  PubMed  Google Scholar 

  28. Morris J, Spencer JA, Ambrose NS (2000) MR imaging classification of perianal fistulas and its implications for patient management. Radiographics 20:623–635

    Article  CAS  PubMed  Google Scholar 

  29. de Miguel Criado J, del Salto LG, Rivas PF, et al. (2012) MR imaging evaluation of perianal fistulas: spectrum of imaging features. Radiographics 32:175–194

    Article  Google Scholar 

  30. van Koperen PJ, Bemelman WA, Gerhards MF, et al. (2011) The anal fistula plug treatment compared with the mucosal advancement flap for cryptoglandular high transsphincteric perianal fistula: a double-blinded multicenter randomized trial. Dis Colon Rectum 54:387–393

    Article  PubMed  Google Scholar 

  31. Beets-Tan RG, Beets GL, van der Hoop AG, et al. (2001) Preoperative MR imaging of anal fistulas: does it really help the surgeon? Radiology 218:75–84

    Article  CAS  PubMed  Google Scholar 

  32. Buchanan G, Halligan S, Williams A, et al. (2002) Effect of MRI on clinical outcome of recurrent fistula-in-ano. Lancet 360:1661–1662

    Article  PubMed  Google Scholar 

  33. Makris GM, Poulakaki N, Papanota AM, et al. (2017) Vulvar, perianal and perineal cancer after hidradenitis suppurativa: a systematic review and pooled analysis. Dermatol Surg 43:107–115

    Article  CAS  PubMed  Google Scholar 

  34. Thomas M, Bienkowski R, Vandermeer TJ, Trostle D, Cagir B (2010) Malignant transformation in perianal fistulas of Crohn’s disease: a systematic review of literature. J Gastrointest Surg 14:66–73

    Article  PubMed  Google Scholar 

  35. Schwartz DA, Loftus EV Jr, Tremaine WJ, et al. (2002) The natural history of fistulizing Crohn’s disease in Olmsted County, Minnesota. Gastroenterology 122:875–880

    Article  PubMed  Google Scholar 

  36. Hellers G, Bergstrand O, Ewerth S, et al. (1980) Occurrence and outcome after primary treatment of anal fistulae in Crohn’s disease Gut 21:525–527

    CAS  PubMed  Google Scholar 

  37. Langman JM, Rowland R (1992) Density of lymphoid follicles in the rectum and at the anorectal junction. J Clin Gastroenterol 14:81–84

    Article  CAS  PubMed  Google Scholar 

  38. Tang LY, Rawsthorne P, Bernstein CN (2006) Are perineal and luminal fistulas associated in Crohn’s disease? A population-based study. Clin Gastroenterol Hepatol 4:1130–1134

    Article  PubMed  Google Scholar 

  39. Wise PE, Schwartz DA (2012) The Evaluation and treatment of Crohn perianal fistulae: EUA, EUS, MRI, and other imaging modalities. Gastroenterol Clin N Am 41:379–391

    Article  Google Scholar 

  40. Van Assche G, Vanbeckevoort D, Bielen D, et al. (2003) Persistent fistula tracks in perianal Crohn’s disease after long-term infliximab treatment: correlation with clinical outcome. Gastroenterology 125:1025–1031

    Article  PubMed  Google Scholar 

  41. Ng SC, Plamondon S, Gupta A, et al. (2009) Prospective evaluation of anti-tumor necrosis factor therapy guided by magnetic resonance imaging for Crohn’s perineal fistulas. Am J Gastroenterol 104:2973–2986

    Article  CAS  PubMed  Google Scholar 

  42. Makowiec F, Jehle EC, Becker HD, et al. (1997) Perianal abscess in Crohn’s disease. Dis Colon Rectum 40:443–450

    Article  CAS  PubMed  Google Scholar 

  43. Williamson PR, Hellinger MD, Larach SW, et al. (1995) Twenty-year review of the surgical management of perianal Crohn’s disease. Dis Colon Rectum 38:389–392

    Article  CAS  PubMed  Google Scholar 

  44. Bayer I, Gordon PH (1994) Selected operative management of fistula-in-ano in Crohn’s disease. Dis Colon Rectum 37:760–765

    Article  CAS  PubMed  Google Scholar 

  45. Van Assche G, Vanbeckevoort D, Bielen D, et al. (2003) Persistent fistula tracks in perianal Crohn’s disease after long-term infliximab treatment: correlation with clinical outcome. Gastroenterology 125:1025–1031

    Article  PubMed  Google Scholar 

  46. Savoye-Collet C, Savoye G, Koning E, et al. (2011) Fistulizing perianal Crohn’s disease: contrast-enhanced magnetic resonance imaging assessment at 1 year on maintenance anti-TNF-alpha therapy. Inflamm Bowel Dis 17:1751–1758

    Article  CAS  PubMed  Google Scholar 

  47. Karmiris K, Bielen D, Vanbeckevoort D, et al. (2011) Long-term monitoring of infliximab therapy for perianal fistulizing Crohn’s disease by using magnetic resonance imaging. Clin Gastroenterol Hepatol 9:130–136

    Article  CAS  PubMed  Google Scholar 

  48. Baker B, Al-Salman M, Daoud F (2014) Management of acute perianal sepsis in neutropenic patients with hematological malignancy. Tech Coloproctol 18:327–333

    Article  CAS  PubMed  Google Scholar 

  49. Plumb AA, Halligan S, Bhatnagar G, Taylor SA (2015) Perianal sepsis in hematologic malignancy: MR imaging appearances and distinction from cryptoglandular infection in immunocompetent patients. Radiology 276:147–155

    Article  PubMed  Google Scholar 

  50. Billingham RP, Isler JT, Kimmins MH, et al. (2004) The diagnosis and management of common anorectal disorders. Curr Probl Surg 41:586–645

    Article  PubMed  Google Scholar 

  51. Taylor SA, Halligan S, Bartram CI (2003) Pilonidal sinus disease: MR imaging distinction from fistula in ano. Radiology. 226:662–667

    Article  PubMed  Google Scholar 

  52. Kelly AM, Cronin P (2005) MRI features of hidradenitis suppurativa and review of the literature. AJR Am J Roentgenol 185:1201–1204

    Article  PubMed  Google Scholar 

  53. Takiyama H, Kazama S, Tanoue Y, et al. (2015) Efficacy of magnetic resonance imaging in the diagnosis of perianal hidradenitis suppurativa, complicated by anal fistulae: a report of two cases and review of the literature. Int J Surg Case Rep 15:107–111

    Article  PubMed  PubMed Central  Google Scholar 

  54. Griffin N, Williams AB, Anderson S, et al. (2014) Hidradenitis suppurativa: MRI features in anogenital disease. Dis Colon Rectum 57:762–771

    Article  PubMed  Google Scholar 

  55. Das B, Snyder M (2016) Rectovaginal fistulae. Clin Colon Rectal Surg. 29:50–56

    Article  PubMed  PubMed Central  Google Scholar 

  56. Dwarkasing S, Hussain SM, Hop WC, Krestin GP (2004) Anovaginal fistulas: evaluation with endoanal MR imaging. Radiology 231:123–128

    Article  PubMed  Google Scholar 

  57. Felt-Bersma RJ, Bartelsman JF (2009) Haemorrhoids, rectal prolapse, anal fissure, peri-anal fistulae and sexually transmitted diseases. Best Pract Res Clin Gastroenterol 23:575–592

    Article  PubMed  Google Scholar 

  58. Perry WB, Dykes SL, Buie WD, Rafferty JF (2010) Practice parameters for the management of anal fissures (3rd revision). Dis Colon Rectum 53:1110–1115

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, School of Medicine, Ankara University, Talatpaşa Bulvarı, Sıhhiye, 06100, Ankara, Turkey

    Ayşe Erden

Authors
  1. Ayşe Erden
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ayşe Erden.

Ethics declarations

Funding

 No funding was received.

Conflict of interest

The author declares that she has no conflict of interest.

Ethical approval

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 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Erden, A. MRI of anal canal: normal anatomy, imaging protocol, and perianal fistulas: Part 1. Abdom Radiol 43, 1334–1352 (2018). https://doi.org/10.1007/s00261-017-1305-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-017-1305-2

Keywords

Search

Navigation