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Diffusion-weighted MR imaging for the diagnosis of abscess complicating fistula-in-ano: preliminary experience

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To investigate the role of diffusion-weighted magnetic resonance imaging (DWMRI) in the diagnosis of abscess-complicating fistula-in-ano.

Methods

This retrospective study was approved by our Institutional Review Board and informed consent was waived. MRI examinations, including fat-suppressed T2-weighted turbo spin-echo (T2-TSE) MRI and DWMRI, of 24 patients with a fistula-in-ano, were reviewed by two independent readers for the presence and number of visible fistulas, conspicuity and apparent diffusion coefficient (ADC) measurement of suspected fistula tracks and pelvic collections. The reference standard was surgical with follow-up findings.

Results

Sensitivity was 91.2 % [95 % CI: 76 %-98 %] for T2-weighted TSE MRI and 100 % [95 % CI: 90 %-100 %] for DWMRI detecting fistulas. ADC values were lower in abscesses than in inflammatory masses (P = 0.714.10-6). The area under the ROC curve was 0.971 and the optimal cut-off ADC value was 1.186 × 10-3 mm2/s, yielding a sensitivity of 100 % [95 % CI: 77 %-100 %], a specificity of 90 % [95 % CI: 66 %-100 %], a positive predictive value of 93 % [95 % CI: 82.8 %-100 %] and a negative predictive value of 90 % [95 % CI: 78 %-100 %] for an abscess diagnosis. Fistula conspicuity was greater with DWMRI than with T2-TSE MRI for the two observers (P = 0.0034 and P = 0.0007).

Conclusion

DWMRI shows high sensitivity and specificity for the diagnosis of perianal abscesses and helps discriminate between an abscess and inflammatory mass. Conspicuity of fistulas-in-ano is greater with DWMRI than with T2-weighted TSE MRI.

Key Points

DWMRI can differentiate between pelvic abscess and inflammatory mass.

DWMRI helps avoid gadolinium-chelate administration in patients with a suspected fistula-in-ano.

DWMRI provides high degrees of conspicuity for fistula-in-ano.

Conspicuity of fistulas is better with DWMRI imaging than with T2-TSE-weighted MRI.

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References

  1. 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  PubMed  CAS  Google Scholar 

  2. Caprilli R, Gassull MA, Escher JC et al (2006) European evidence based consensus on the diagnosis and management of Crohn's disease: special situations. Gut 55:36–58

    Article  Google Scholar 

  3. Haggett PJ, Moore NR, Shearman JD, Travis SP, Jewell DP, Mortensen NJ (1995) Pelvic and perineal complications of Crohn's disease: assessment using magnetic resonance imaging. Gut 36:407–410

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  4. Schwartz DA, Wiersema MJ, Dudiak KM et al (2001) A comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluation of Crohn's perianal fistulas. Gastroenterology 121:1064–1072

    Article  PubMed  CAS  Google Scholar 

  5. 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 

  6. Keshaw H, Foong KS, Forbes A, Day RM (2010) Perianal fistulae in Crohn's disease: current and future approaches to treatment. Inflamm Bowel Dis 16:870–880

    Article  PubMed  Google Scholar 

  7. Horsthuis K, Lavini C, Bipat S, Stokkers PCF, Stoker J (2009) Perianal Crohn disease: evaluation of dynamic contrast-enhanced MR imaging as an indicator of disease activity. Radiology 251:380–387

    Article  PubMed  Google Scholar 

  8. Villa C, Pompili G, Franceschelli G et al (2012) Role of magnetic resonance imaging in evaluation of the activity of perianal Crohn's disease. Eur J Radiol 81:616–622

    Article  PubMed  Google Scholar 

  9. Yoshizako T, Wada A, Takahara T et al (2012) Diffusion-weighted MRI for evaluating perianal fistula activity: feasibility study. Eur J Radiol 81:2049–2053

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  11. Yildirim N, Gokalp G, Özturk E et al (2012) Ideal combination of MRI sequences for perianal fistula classification and the evaluation of additional findings for readers with varying levels of experience. Diagn Interv Radiol 18:11–19

    PubMed  Google Scholar 

  12. Colosio A, Fornes P, Soyer P, Lewin M, Loock M, Hoeffel C (2013) Local colorectal cancer recurrence: pelvic MRI evaluation. Abdom Imaging 38:72–81

    Article  PubMed  CAS  Google Scholar 

  13. Loock MT, Fornes P, Soyer P, Graesslin O, Lafont C, Hoeffel C (2012) MRI and pelvic abscesses: a pictorial review. Clin Imaging 36:425–431

    Article  PubMed  Google Scholar 

  14. Nguyen TL, Soyer P, Barbe C et al (2013) Diagnostic value of diffusion-weighted magnetic resonance imaging in pelvic abscesses. J Comput Assist Tomogr 37:971–979

    Article  PubMed  Google Scholar 

  15. Hori M, Oto A, Orrin S, Suzuki K, Baron RL (2009) Diffusion-weighted MRI: a new tool for the diagnosis of fistula in ano. J Magn Reson Imaging 30:1021–1026

    Article  PubMed  Google Scholar 

  16. Van Assche G, Vanbeckevoort D, Bielen D et al (2003) Magnetic resonance imaging of the effects of infliximab on perianal fistulizing Crohn's disease. Am J Gastroenterol 98:332–339

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  18. Landis JR, Koch GG (1977) An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics 33:363–374

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  20. Soyer P, Boudiaf M, Place V et al (2011) Preoperative detection of hepatic metastases: comparison of diffusion-weighted, T2-weighted fast spin echo and gadolinium-enhanced MR imaging using surgical and histopathologic findings as standard of reference. Eur J Radiol 80:245–252

    Article  PubMed  Google Scholar 

  21. Kyriazi S, Collins DJ, Messiou C et al (2011) Metastatic ovarian and primary peritoneal cancer: assessing chemotherapy response with diffusion-weighted MR imaging–value of histogram analysis of apparent diffusion coefficients. Radiology 261:182–192

    Article  PubMed  Google Scholar 

  22. Murtz P, Krautmacher C, Traber F, Gieseke J, Schild HH, Willinek WA (2007) Diffusion-weighted whole-body MR imaging with background body signal suppression: a feasibility study at 3.0 Tesla. Eur Radiol 17:3031–3037

    Article  PubMed  Google Scholar 

  23. Thoeny HC, Forstner R, De Keyzer F (2012) Genitourinary applications of diffusion-weighted MR imaging in the pelvis. Radiology 263:326–342

    Article  PubMed  Google Scholar 

  24. Park HJ, Kim SH, Jang KM, Lee SJ, Park MJ, Choi D (2013) Differentiating hepatic abscess from malignant mimickers: value of diffusion-weighted imaging with an emphasis on the periphery of the lesion. J Magn Reson Imaging 38:1333–1341

    Article  PubMed  Google Scholar 

  25. Zappa M, Stefanescu C, Cazals-Hatem D et al (2011) Which magnetic resonance imaging findings accurately evaluate inflammation in small bowel Crohn's disease? A retrospective comparison with surgical pathologic analysis. Inflamm Bowel Dis 17:984–993

    Article  PubMed  Google Scholar 

  26. Chopra T, Kandukurti K, Shah S, Ahmed R, Panesar M (2012) Understanding nephrogenic systemic fibrosis. Int J Nephrol 2012:912189

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

The scientific guarantor of this publication is Anthony DOHAN, MD. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, case-control study, performed at one institution.

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Dohan, A., Eveno, C., Oprea, R. et al. Diffusion-weighted MR imaging for the diagnosis of abscess complicating fistula-in-ano: preliminary experience. Eur Radiol 24, 2906–2915 (2014). https://doi.org/10.1007/s00330-014-3302-y

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  • DOI: https://doi.org/10.1007/s00330-014-3302-y

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