International Journal For Multidisciplinary Research

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A study of the correlation of MRI Fistulogram with operative findings in perianal fistula.

Author(s) Dr. Neeraj Singh, Dr. Lavan Saxena, Dr. Muktakar Singh, Dr. Robin Verma, Dr. Ansika Yadav, Dr. Jayesh Bonde, Dr.Tanzeem Siddiqui, Dr. Jyothi Kadipikonda
Country India
Abstract ABSTRACT
BACKGROUND: Perianal fistula is a common anorectal condition with high recurrence rates. Accurate preoperative anatomical mapping is essential to guide surgical strategy and reduce morbidity. While MRI has emerged as the preferred imaging modality, prospective validation against intraoperative findings remains limited in Indian populations.
OBJECTIVE: To correlate MRI fistulogram findings with operative observations in patients with perianal fistula and validate its diagnostic accuracy.

MATERIAL AND METHOD- This prospective observational study was conducted in the Department of Radio-Diagnosis at a tertiary care hospital. About 50 clinically suspected patients of ischemic stroke underwent MRI brain including DWI and ADC sequences at 1.5 Tesla Philips MRI machine. The distribution of infarcts, vascular territory involvement, and ADC values were analyzed and correlated with the clinical stage of infarction.

METHODS: This hospital-based prospective observational study enrolled 50 consecutive patients with clinically suspected/diagnosed primary perianal fistula. All patients underwent 1.5-Tesla MRI fistulography with standardized protocols including T1-weighted, T2-weighted, fat-suppressed, diffusion-weighted, and post-contrast sequences. Fistulas were classified using the St. James University Hospital criteria. MRI findings were compared with intraoperative observations as the gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated.
RESULTS: Mean patient age was 48.2 ± 14.5 years (range 21-75 years) with male predominance (82%). Most fistulas were Grade I (52%). MRI demonstrated excellent concordance with surgical findings: internal openings (96% sensitivity), external openings (100% sensitivity), secondary tracts (80% sensitivity, 93.3% specificity), abscesses (86.36% sensitivity, 96.43% specificity), and horseshoe tracts (78.57% sensitivity, 97.22% specificity). Overall agreement rates for St. James classification ranged from 83.3% to 100%. Diagnostic accuracy for most parameters exceeded 88%.
CONCLUSION: MRI fistulogram is a highly accurate, non-invasive imaging modality for preoperative evaluation of perianal fistula, demonstrating strong correlation with intraoperative findings. Its routine use in preoperative assessment can significantly improve surgical planning, reduce recurrence rates, and help preserve continence.
Keywords Perianal fistula, Fistulogram, MRI, Anorectal surgery, St. James classification, Diagnostic accuracy
Field Medical / Pharmacy
Published In Volume 8, Issue 2, March-April 2026
Published On 2026-04-16
DOI https://doi.org/10.36948/ijfmr.2026.v08i02.74744
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