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European Radiology
Published in: European Radiology 11/2014

01-11-2014 | Gastrointestinal

Diffusion-weighted MR imaging for the diagnosis of abscess complicating fistula-in-ano: preliminary experience

Authors: Anthony Dohan, Clarisse Eveno, Raluca Oprea, Karine Pautrat, Vinciane Placé, Marc Pocard, Christine Hoeffel, Mourad Boudiaf, Philippe Soyer

Published in: European Radiology | Issue 11/2014

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Abstract

Objective

To investigate the role of diffusion-weighted magnetic resonance imaging (DWMRI) in the diagnosis of abscess-complicating fistula-in-ano.

Methods

This retrospective study was approved by our Institutional Review Board and informed consent was waived. MRI examinations, including fat-suppressed T2-weighted turbo spin-echo (T2-TSE) MRI and DWMRI, of 24 patients with a fistula-in-ano, were reviewed by two independent readers for the presence and number of visible fistulas, conspicuity and apparent diffusion coefficient (ADC) measurement of suspected fistula tracks and pelvic collections. The reference standard was surgical with follow-up findings.

Results

Sensitivity was 91.2 % [95 % CI: 76 %-98 %] for T2-weighted TSE MRI and 100 % [95 % CI: 90 %-100 %] for DWMRI detecting fistulas. ADC values were lower in abscesses than in inflammatory masses (P = 0.714.10-6). The area under the ROC curve was 0.971 and the optimal cut-off ADC value was 1.186 × 10-3 mm2/s, yielding a sensitivity of 100 % [95 % CI: 77 %-100 %], a specificity of 90 % [95 % CI: 66 %-100 %], a positive predictive value of 93 % [95 % CI: 82.8 %-100 %] and a negative predictive value of 90 % [95 % CI: 78 %-100 %] for an abscess diagnosis. Fistula conspicuity was greater with DWMRI than with T2-TSE MRI for the two observers (P = 0.0034 and P = 0.0007).

Conclusion

DWMRI shows high sensitivity and specificity for the diagnosis of perianal abscesses and helps discriminate between an abscess and inflammatory mass. Conspicuity of fistulas-in-ano is greater with DWMRI than with T2-weighted TSE MRI.

Key Points

• DWMRI can differentiate between pelvic abscess and inflammatory mass.
• DWMRI helps avoid gadolinium-chelate administration in patients with a suspected fistula-in-ano.
• DWMRI provides high degrees of conspicuity for fistula-in-ano.
• Conspicuity of fistulas is better with DWMRI imaging than with T2-TSE-weighted MRI.
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Metadata
Title
Diffusion-weighted MR imaging for the diagnosis of abscess complicating fistula-in-ano: preliminary experience
Authors
Anthony Dohan
Clarisse Eveno
Raluca Oprea
Karine Pautrat
Vinciane Placé
Marc Pocard
Christine Hoeffel
Mourad Boudiaf
Philippe Soyer
Publication date
01-11-2014
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 11/2014
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-014-3302-y

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