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DIAGNOSTIC ACCURACY OF DIFFUSION WEIGHTED IMAGING IN DETECTION OF PERIANAL FISTULA TAKING SURGICAL FINDINGS AS GOLD STANDARD

Asad Aziz, Muhammad Mubeen Ul Haq, Saad Qayyum, Ali Zul Hasnain

Introduction: DWI MRI is useful in assessing anal fistulas because it allows detecting small and multiple tracks simultaneously and assessing their degree of inflammation and can be used for monitoring. Aim: To determine the diagnostic accuracy of the diffusion-weighted image for the diagnosis of perianal fistula, taking the surgical results as the gold standard. Study design: Descriptive, cross-sectional. Study time: From August 30, 2017 to February 29, 2018. Location: Department of Radiology, United Military Hospital, Lahore Materials and methods: The study included 218 patients aged 20 to 60 years with symptoms of rectal fistula. Patients with recurrent fistula who were unable to perform MRI were excluded from the study. DW-MRI was performed in all patients and a rectal fistula was sought. DW-MRI results correlated with surgical results. Results: The mean age was 46.51 ± 9.82 years. Of these 218 patients, 132 (60.55%) were male, 86 (39.45%) were 2.5: 1 women, DW-MRI positive, true positive were 123 cases and false positive were 12. Of the 83 DW-MRI negative patients, false negative cases were 10 and true negative cases were 73. Overall specificity, sensitivity, positive, negative predictive value, predictive value and diagnostic accuracy of diffusion weighted imaging for the diagnosis of perianal fistula taking surgical findings as gold standard was 92.48%, 85.88%, 91.11%, 87.95% and 89.91% respectively. Conclusion: This study showed that DW-MRI is a very sensitive and precise method of preoperative detection of perianal fistula. Key words: perianal fistula, weighted diffusion image, non-invasive, sensitivity.

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