Mehmet BAYRAK, Yasemin ALTINTAŞ, Ömer ALABAZ, Medih ÇELİKTAŞ

Preoperatif manyetik rezonans görüntülemenin anal fistül tanı ve cerrahi tedavisine katkısı

Amaç: Bu çalışma, anal fistülü olan hastalarda MR görüntülemenin doğruluğunu ve MR görüntülemeyle kantitatif olarak eklenen bilgileri araştırmayı ve MR görüntülemenin tamamlayıcı bilgi sağlama olasılığının daha yüksek olduğu hasta grubunu belirlemeyi amaçlamaktadır. Gereç ve Yöntem: Bu çalışma 15 Ocak 2018-15 Haziran 2020 tarihleri arasında primer anal fistül tanısı alan, cerrahi ve preoperatif MR görüntüleme yapılan hastalar retrospektif olarak değerlendirildi. Preoperatif olarak çekilen manyetik resonance görüntüleri incelenerek tedavi ve teşhise katkı sağlayan ek bilgiler elde edildi. Cerrahi bulgular ile manyetik rezonans görüntüleme bulguları arasındaki tutarsızlıklar kaydedildi. Bulgular: Çalışmamız 92 erkek ve 68 kadın olmak üzere 179 trakttı olan 160 hastayı içermekte idi. Yaş ortalaması 44,6 ± 10,1 (18-65) yıl idi. Toplamda 97 (%60,6) hastada nüks fistül mevcuttu. MR görüntülemenin ﬁstula traktlarının saptanmasında özgüllüğü ve duyarlılığı sırasıyla %93,5 ve %98,9 idi. MR görüntülemenin fistula traktını ve iç açıklığı saptamadaki tanısal doğruluğu sırasıyla %97,8 ve %97,5 idi. Ameliyat öncesi MR görüntülemenin katkısı, dış açıklık anal kanaldan 3 cm'in üzerinde ise ve at nalı fistülü bulunduğunda istatistiksel olarak daha anlamlıydı. Sonuç: Manyetik rezonans görüntüleme hem fistula traktlarını hem de iç açıklığı tespit etmede yüksek özgüllüğe, duyarlılığa ve tanısal doğruluğa sahip olduğunu saptadık. Manyetik rezonans görüntülemenin tüm basit ve kompleks fistüllerde rutin olarak kullanılması gerektiğini öneriyoruz.

Contribution of preoperative magnetic resonance imaging in diagnosis and surgical treatment of anal fistula

Purpose: This study aims to investigate the accuracy of MR imaging in patients with anal fistula and the information quantitatively added by MR imaging and to identify the group of patients where MR imaging is more likely to provide complementary information. Materials and Methods: The present cohort was a retrospective work of consecutive patients diagnosed with primary anal fistula who underwent surgery and preoperative MR imaging between 15 January 2018 and 15 June 2020. Any complementary radiological information was derived from preoperative MR imaging reports. The inconsistencies were noted between surgical findings and MR imaging records. Results: The study consisted of 160 patients with 179 tracts, 92 men and 68 women. The mean patient age was 44.6±10.1 (18-65) years. In total, 97 patients suffered from recurrent fistulas (60.6%). The speciﬁcity and sensitivity of MR imaging in detecting ﬁstula tracts were 93.5 and 98.9 % %, respectively. The diagnostic accuracy of MR imaging in identifying the fıstula tract and internal opening was 97.8 % and 97.5%, respectively. The contribution of preoperative MR imaging was statistically more significant if the external opening was over 3 cm from the anal canal (10.9% vs. 47.8%,) and when a horseshoe fistula was present (39.6% vs. 63.8%). Conclusion: We found that MR imaging had high speciﬁcity, sensitivity, and diagnostic accuracy in discovering both ﬁstula tracts and the internal opening, we consider that MR imaging should be used routinely in almost all simple and complex fistulas.

Keywords:

anal fistula, magnetic resonance imaging, surgical treatment,

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