DIAGNOSTIC ACCURACY OF MRI IN PREOPERATIVE ASSESSMENT OF PERIANAL FISTULAE

Authors

  • Hassan Majeed Senior Medical Officer, Ayub Teaching Hospital Abbottabad
  • Hamza Javed Resident Radiologist, Radiology Department- ATH, Abbottabad
  • Tayyaba Alam Resident Radiologist, Radiology Department- ATH, Abbottabad
  • Alina Farooq Resident Radiologist, Radiology Department- ATH, Abbottabad
  • Faiza Akram Professor, Radiology Department- ATH, Abbottabad

Keywords:

Perianal fistula, Anal fistula, Preoperative assessment, Magnetic resonance imaging, Diagnostic Accuracy, Surgical correlation

Abstract

Background: Perianal fistulae are challenging anorectal conditions characterized by abnormal tracts between the anal canal or rectum and the perianal skin. Accurate preoperative diagnosis is essential to map the fistula, prevent recurrence, and minimize complications. MRI has emerged as a non-invasive and highly sensitive modality for evaluating perianal fistulae. This study aimed to assess the diagnostic accuracy of MRI in preoperative evaluation, using surgical findings as the gold standard. Methods: This cross-sectional validation study was conducted at the Department of Diagnostic Radiology, Ayub Teaching Hospital, Abbottabad, over two years. Patients with clinical suspicion of perianal fistula underwent MRI using a 1.5 Tesla scanner. Standard imaging protocols included T1-weighted, STIR, and T2-weighted sequences. Surgical findings were recorded as the gold standard for comparison to calculate the validity parameters. Results: Most of the participants, 107/157 (68.2%), were male with a mean age of 53.47±13.02 years and a mean BMI of 24.45±3.19. MRI demonstrated high sensitivity (95.89%), specificity (81.82%), PPV (98.59%), NPV (60%), and an overall diagnostic accuracy of 95.2%. It accurately identified fistulous tracts, internal and external openings, and secondary extensions. MRI findings correlated strongly with surgical observations (p<0.001). Conclusions: MRI is a highly accurate, non-invasive imaging tool for precise anatomical mapping of primary and secondary fistulous tracts and abscesses, aiding in precise preoperative assessment and planning. Integrating MRI into diagnostic workflows is especially beneficial in resource-constrained settings by alleviating the economic and emotional burden associated with repeated surgeries and postoperative complications caused by incomplete preoperative assessment.

References

1. Soker G, Gulek B, Yilmaz C, Kaya O, Arslan M, Dilek O, et al. The comparison of CT fistulography and MR imaging of perianal fistulae with surgical findings: a case-control study. Abdom Radiol (NY) 2016;41(8):1474–83

2. Brillantino A, Iacobellis F, Reginelli A, Monaco L, Sodano B, Tufano G, et al. Preoperative assessment of simple and complex anorectal fistulas: Tridimensional endoanal ultrasound? Magnetic resonance? Both? Radiol Med 2019;124(5):321–30.

3. Baysal H, Kazcı ZN, Alimoğlu O. Comparison of preoperative MRI and surgical findings in perianal fistulas and factors affecting recurrence. J Health Sci Med 2023;6(6):1380–6.

4. Minhas S, Raja R, Khaliq M, Mahmood H, Raza SM, Mughal HH. Diagnostic accuracy of magnetic resonance imaging (MRI) in detecting and grading perianal fistula, taking operative findings as gold standard. Rawal Med J 2023;48(3):647–50.

5. Cavusoglu M, Duran S, Sözmen Cılız D, Tufan G, Hatipoglu Çetin HG, Ozsoy A, et al. Added value of diffusion-weighted magnetic resonance imaging for the diagnosis of perianal fistula. Diagn Interv Imaging 2016;97:123–31.

6. Fahmy DM, Dawoud MG. Value of diffusion-weighted MRI in assessment of simple and complicated perianal fistula. Egypt J Radiol Nucl Med 2017;48:345–50.

7. Zhao WW, Yu J, Shu J, Sha JT, Li CY, Zeng J, et al. Precise and comprehensive evaluation of perianal fistulas, classification, and related complications using magnetic resonance imaging. Am J Transl Res 2023;15(5):3674–85.

8. Konan A, Onur MR, Özmen MN. The contribution of preoperative MRI to the surgical management of anal fistulas. Diagn Interv Radiol 2018;24:321–7.

9. Khan NA, Kiran S, Mir RA, Dar SA, Salroo IN. A study of preoperative assessment of perianal fistulas using MRI. Int J Health Sci 2022;6(S5):12066–79.

10. Daabis N, El Shafey R, Zakaria Y, Elkhadrawy O. Magnetic resonance imaging evaluation of perianal fistula. Egypt J Radiol Nucl Med 2013;44:705–11.

11. Singh K, Singh N, Thukral CL, Singh KP, Bhalla V. Magnetic Resonance Imaging (MRI) Evaluation of Perianal Fistulae with Surgical Correlation. J Clin Diagn Res 2014;8:RCO1–4.

12. García-Olmo D, Van Assche G, Tagarro I, Diez MC, Richard MP, Khalid JM, . et al. Prevalence of Anal Fistulas in Europe: Systematic Literature Reviews and Population-Based Database Analysis. Adv Ther 2019;36(12):3503–18.

13. Hashmi M, Ahmed T, Khan A, Arija D, Rehman M, Ahmed SMU. Factors increasing the risk of recurrence in fistula in ano. J Popul Ther Clin Pharmacol 2024;31(6):1425–32.

14. Ahmed A, Tamkeen N, Khan MR, Wahid G, Fahim S, Badshah U. Diagnostic accuracy of magnetic resonance imaging in evaluation of perianal fistula keeping surgical finding as gold standard. Med Forum 2023;34(4):19–21.

15. Aly RA, Badr MA, Korayem EM, Abdalsalam OH, Omar H. Role of MRI in classification and preoperative evaluation of perianal fistula. Egypt J Radiol Nucl Med 2024;55:141.

16. Madany AH, Murad AF, Kabbash MM, Ahmed HM. Magnetic resonance imaging in the workup of patients with perianal fistulas. Egypt J Radiol Nucl Med 2023;54(1):50.

17. Ishfaq S, Qamar MA, Zaman M. Diagnostic Accuracy of Magnetic Resonance Imaging in Perianal Fistula Taking Surgical Findings as Gold Standard. Pak Med Heal Sci 2016;10(3):939–41.

18. Varsamis N, Kosmidis C, Chatzimavroudis G, Apostolidou Kiouti F, Efthymiadis C, Lalas V, et al. Preoperative assessment of perianal fistulas with combined magnetic resonance and tridimensional endoanal ultrasound: a prospective study. Diagnostics (Basel) 2023;13(17):2851.

19. Vo D, Phan C, Nguyen L, Le H, Nguyen T, Pham H. The role of magnetic resonance imaging in the preoperative evaluation of anal fistulas. Sci Rep 2019;9(1):17947.

20. Arkenbosch JHC, van Ruler O, de Vries AC, van der Woude CJ, Dwarkasing RS. The role of MRI in perianal fistulizing disease: diagnostic imaging and classification systems to monitor disease activity. Abdom Radiol (NY) 2025;50(2):589–97.

21. Ahmad MW, Shehzadi HS, Dogar IH, Rashid N, Tayyab MA, Qureshi UA, et al. Magnetic resonance imaging (MRI) evaluation of perianal fistula with surgical correlation. Pak J Med Health Sci 2023;17(3):230–4.

22. Halligan S, Tolan D, Amitai MM, Hoeffel C, Kim SH, Maccioni F, et al. ESGAR consensus statement on the imaging of fistula-in-ano and other causes of anal sepsis. Eur Radiol 2020;30(9):4734–40.

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Published

2026-08-24

How to Cite

1.
Majeed H, Javed H, Alam T, Farooq A, Akram F. DIAGNOSTIC ACCURACY OF MRI IN PREOPERATIVE ASSESSMENT OF PERIANAL FISTULAE. J Ayub Med Coll Abbottabad [Internet]. 2026 Aug. 24 [cited 2026 Sep. 10];38(1):6-11. Available from: https://jamc.ayubmed.edu.pk/index.php/jamc/article/view/14490

Issue

Vol. 38 No. 1 (2026): Journal of Ayub Medical College Abbottabad

Section

ORIGINAL ARTICLE

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Copyright (c) 2026 Hassan Majeed, Hamza Javed, Tayyaba Alam, Alina Farooq, Faiza Akram

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