Open AccessPower of 3D Transrectal Ultrasonography and Magnetic Resonance Imaging in Diagnosis of Cryptogenic Rectal Fistulae
Author(s) -
Д. О. Киселев,
I. V. Zarodnyuk,
Yu. L. Trubacheva,
Р. Р. Елигулашвили,
A. V. Мatinyan,
И. В. Костарев
Publication year - 2020
Publication title -
kubanskij naučnyj medicinskij vestnik
Language(s) - English
Resource type - Journals
eISSN - 2541-9544
pISSN - 1608-6228
DOI - 10.25207/1608-6228-2020-27-6-44-59
Subject(s) - medicine , magnetic resonance imaging , transrectal ultrasonography , ultrasound , radiology , physical examination , colorectal surgery , ultrasonography , rectal examination , sphincter , internal anal sphincter , rectum , surgery , anal canal , abdominal surgery , prostate , cancer
Background . The only radical curative treatment for rectal stulae is surgery. The choice of surgery requires precise characterisation of the stulous tract. The most common instrumental methods for rectal stula diagnosis are transrectal ultrasonography (TRUS) and magnetic resonance imaging (MRI). Objectives . Comparative assessment of the diagnostic power of 3D TRUS and MRI techniques in revealing cryptogenic anal stulae with respect to intraoperative examination. Methods . The study enrolled 92 patients with rectal stulae aged 27 to 66 years. Fistulous opening was external in 47 (51.1%) and obliterated in 45 (48.9%) patients. The average patient age was 42.7 ± 15.9 years. Surgery for acute paraproctitis 14 to 32 days prior to examination was in history of 58 (63.1%) patients. All patients had preoperative subsequent 3D TRUS and MRI compared with intraoperative examination results. Results . The rate of correct stulous tract type diagnosis veried with intraoperative revision was 96.7% (89/92) with 3D TRUS and 82.6% (76/92) with MRI ( p = 0.0027). The error rate of 3D TRUS estimation of external sphincter involvement was 1.1% (1/92), sensitivity 96.6%, specicity 93.5%, overall accuracy 94.5%. The MRI error rate was 21.7% (20/92), with a statistically signicant difference for sensitivity and overall accuracy ( p < 0.0001). The rate of correct estimation of internal stulous localisation in “anorectal clock” was 97.8% (90/92) with 3D TRUS and 90% (81/90) with MRI ( p = 0.0342). Internal stula was not detected with MRI in 2/92 (2.2%) cases, which explains the deviation. Intraoperative revision identied total 113 abscesses. The rate or correct abscess estimation was 97.3% (110/113) with 3D TRUS and 74.7% (71/95) with MRI. MRI failed to detect abscess in 18/113 (15.9%) cases ( p < 0.0001). Conclusion . 3D transrectal ultrasonography is statistically superior over magnetic resonance imaging in estimating internal stula localisation in “anorectal clock”, stulous type, as well as the stulous tract location relative to external sphincteric tissue in patients with transsphincteric anal stulae. Estimation of pararectal and intramural abscesses was also signicantly different.