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Fistula tracks were visualized as tube-like, hypoechoic lesions. The internal fistula opening was identified as a hypoechoic area in the intersphincteric plane, as a defect in the internal anal sphincter, or as a subepithelial breach that connected to the fistulous tract through an internal sphincter defect [ 8 ].

After the EAUS procedures, the characteristics of the fistula were classified according to the same criteria used in the clinical evaluation.

MR imaging studies were performed on a 1. The patients were placed in the supine position. Each component of the anal fistula was categorized and recorded using the similar criteria of 3D-EAUS.

Fistula tracks were visualized as tube-like, hyperintense or hypointense lesions. The internal fistula opening was identified as a hyperintense or hypointense area in the intersphincteric plane, as a defect in the internal anal sphincter, or as a subepithelial breach that connected to the fistulous tract through an internal sphincter defect.

All patients well tolerated the exam and there were no side effects reported. In Table 3 we showed the different accuracy between MRI and 3D-EAUS in the identification of primary tract, secondary extension, and abscess, considering that one patient could be affected from more symptoms too.

The test with Yates correction showed that in the evaluation of primary tract, secondary extension, and abscess there were no significant differences between MRI and 3D-EAUS Concerning secondary extensions, there were 27 patients No differences were observed concerning detection of each of these findings between the two modalities abscess, 27 versus 25, ; horseshoe track, 17 versus 16, MRI versus 3D-EAUS.

Anal fistulas are a significant cause of morbidity associated with a severe reduction of quality of life. It represents a common clinical problem affecting approximately 0.

Ten percent of CD can have perianal fistula as first presenting symptom, before receiving CD diagnosis.

Anal fistula is defined by an abnormal perianal tract that connects two epithelized surfaces: the anal canal to the perianal skin. Some fistulas have a tendency to recur, despite seemingly curative surgery.

Recurrence is usually due to infection that has gone undetected and untreated [ 1 ]. Perianal fistulas may be caused by several inflammatory conditions and events, including CD [ 13 , 14 ].

The aetiology of perianal disease in CD is debated, and no single factor can be identified as responsible of subsequent anorectal sepsis, probably resulting from a combination of microbiological, immunological, and genetic factors [ 5 ].

The most widely used one is Parks et al. Parks et al. All of these fistula types may be complicated by abscesses and by secondary tracks.

In addition fistulas can spread circumferentially in the intersphincteric space, ischioanal fossa, or supralevator space.

Circumferential branches or abscesses that extend on both sides of the interior opening are known as horseshoe branches or abscesses [ 7 ].

It allows rapid evaluation for specialized equipment, is easy to perform and easily reproducible and painless, and does not require patient preparation.

It provides excellent imaging of the rectal wall, of the internal and external sphincters and of the intersphincteric plane, of muscle mobility, and of the position of the internal opening, essential for planning surgical approach to reduce the risk of incontinence.

This method can be very useful also in the follow-up of anal diseases, both to study surgical drainages and in the postoperative study of anal fistulae.

MRI has the advantage of an excellent intrinsic soft-tissue resolution, thus showing the fistula tract in the context of the surrounding structures.

It has a wider FOV than 3D-EAUS and it is more suited for the assessment of complex branching tracts, the lateral extension into the perianal spaces, and the cranial extension above the levator ani Figure 4 [ 19 , 20 ].

It could be a valid second-level examination in case of abscesses or complex tracts and also through the pelvic diaphragm and finally where internal opening cannot be simply shown [ 20 — 25 ].

In fact, the introduction of 3D technique has optimized US evaluation. MRI is more accurate in comparison to 3D-EUAS in the individuation of suprasphincteric and extrasphincteric fistulas with the reported advantage of an excellent intrinsic soft-tissue resolution and higher panoramicity, thus showing the fistula track in the context of the surrounding structures.

The authors declare that there is no conflict of interests regarding the publication of this paper. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

We will be providing unlimited waivers of publication charges for accepted research articles as well as case reports and case series related to COVID Review articles are excluded from this waiver policy.

Sign up here as a reviewer to help fast-track new submissions. Journal overview. Special Issues. Academic Editor: Fernando de la Portilla.

Received 18 Jun Revised 14 Aug Accepted 19 Aug Published 27 Dec Abstract Aim. Introduction Perianal fistula is a chronic inflammatory condition defined as an abnormal perianal tract that connects two epithelial surfaces, usually the anal canal and the perianal skin [ 1 ].

Methods 2. MRI MR imaging studies were performed on a 1. Results All patients well tolerated the exam and there were no side effects reported.

Table 1. Table 2. Figure 1. Table 3. Proportion of positive patients to 3D-EAUS and MRI in the diagnosis of primary tract of anal fistulas, secondary extensions, and abscess and test with Yates correction.

Figure 2. Submucosal fistula in the superficial plane corresponding to the level of the distal extremity of anal canal. The same plane on MRI b , which could be avoided in this kind of fistulas white arrow ; 3D-EAUS is often sufficient as a preoperative diagnostic method.

Figure 3. Figure 4. On c and d sagittal and axial view, respectively, of anal and perianal region on MRI which is indispensable to demonstrate the complete extension of the extrasphincteric abscess black star and the appearance of edematous surrounding tissues.

Figure 5. References G. Buchanan, S. Halligan, C. Bartram, A. Williams, D. Tarroni, and C.

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The use of 3D imaging to facilitate training during complex fistula surgery

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