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Role of MRI in the Preoperative Evaluation and Characterisation of Perianal Fistulas: A Prospective Observational Study |
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Mulupuru Krishna Sowmya, Kondragunta Chandra Sekhar, Lanka Sahasri, Earna Rohit Kumar, Bayana Roja 1. Assistant Professor, Department of Radiology, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, Andhra Pradesh, India. 2. Professor, Department of Radiology, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, Andhra Pradesh, India. 3. Senior Resident, Department of Radiology, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, Andhra Pradesh, India. 4. Postgraduate, Department of Radiology, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, Andhra Pradesh, India. 5. Postgraduate, Department of Radiology, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, Andhra Pradesh, India. |
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Correspondence Address : Mulupuru Krishna Sowmya, 64-9-17, Chennupati Ramakotaiah Street Patamatalanka, Vijayawada-520010, Andhra Pradesh, India. E-mail: sowmyamulpuri19@gmail.com |
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| ABSTRACT |  | ||||||
: Introduction: A perianal fistula is an inflammatory disorder that frequently requires surgical interventions. Magnetic Resonance Imaging (MRI) is an exceptional technique for soft-tissue characterisation; recent advancements in imaging perianal fistulas with MR fistulography establish MRI as the gold-standard imaging modality. MRI helps detect the primary tract and reveals secondary fistulous tracts and their consequences, such as abscesses. Aim: To classify perianal fistulas using the St. James’s University Hospital (SJUH) grading and Park’s classification, and compare MRI findings with intraoperative surgical findings. Materials and Methods: A prospective observational study was conducted at the Department of Radiodiagnosis at Dr PSIMS and RF Chinnaoutpally, Vijayawada, Andhra Pradesh, India, from December 2022 to December 2025. It included 50 patients who underwent an MRI fistulogram. At the study Institution, T2-weighted (T2W) and T2 fat-suppressed (T2FS) sequences were utilised as the standard imaging protocol on a 1.5 T Philips MRI machine. The variables assessed in the study were primarily presented using descriptive statistics as frequencies (n) and percentages (%). Diagnostic performance was evaluated using sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and p-values to determine statistical significance. Results: A total of 50 patients with clinically suspected perianal fistula were evaluated. The study population age ranged from 18 to 66 years, with a mean age of 43±12 years. Sociodemographically, males predominated with 38 (76%) and females were 12 (24%); most patients were young to middle-aged adults. On MRI, intersphincteric fistula was the most common according to Park’s classification, seen in 29 (58%) cases, followed by transsphincteric in 15 (30%) and suprasphincteric in 2 (4%); no extrasphincteric fistulae were seen, and 4 (8%) were MRI-negative. Based on SJUH classification, Grade-I was the most frequent with 19 (38%), followed by Grade 2 and 3 each 10 (20%), Grade 4 5 (10%), and Grade 5 2 (4%); 4 (8%) showed no MRI findings. MRI shows strong concordance with surgical findings, with 46 (92%) concordance, showing sensitivity 95.8%, specificity 100%, PPV 100%, and NPV 50%. Conclusion: MRI demonstrated excellent diagnostic performance with high sensitivity and specificity, and showed a strong association with intraoperative findings. | |||||||
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| Keywords : Intersphincteric, Magnetic resonance imaging fistulogram, Perianal fistulas, Transsphincteric | |||||||
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DOI and Others :
DOI: 10.7860/IJARS/2026/88974.3112
Date of Submission: Mar 13, 2026 Date of Peer Review: Apr 16, 2026 Date of Acceptance: Jun 03, 2026 Date of Publishing: Jul 01, 2026 AUTHOR DECLARATION: • Financial or Other Competing Interests: None • Was Ethics Committee Approval obtained for this study? Yes • Was informed consent obtained from the subjects involved in the study? Yes • For any images presented appropriate consent has been obtained from the subjects. Yes PLAGIARISM CHECKING METHODS: • Plagiarism X-checker: Mar 16, 2026 • Manual Googling: May 27, 2026 • iThenticate Software: Jun 02, 2026 (9%) ETYMOLOGY: Author Origin EMENDATIONS: 8 |
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