Endoanal ultrasound versus Magnetic resonance Imaging for perianal sepsis
Date First Published:
December 6, 2001
Last Updated:
December 14, 2001
Report by:
Aamir Z Khan, Specialist Registrar General Surgery (Dept of Surgery, East Surrey Hospital)
Search checked by:
Xavier Escofet, Dept of Surgery, East Surrey Hospital
Three-Part Question:
[For Recurrent Perianal sepsis] [is magentic resonance imaging better than endoanal ultrasound] for [evaluating fistulous tracks]
Clinical Scenario:
A 20 year old female presents to casualty with complaints of recurrent pain and swelling in the perianal region. She has had similiar symptoms in the past and a perianal abscess was drained in the past but never really healed. On examination she has a small abscess with a fistulous track palpable. A diagnosis of recurrent perianal abscess is with an underlying fistula in ano. What is the evidence for the best available investigation to map the fistulous tracks.
Search Strategy:
Medline 1966-12/01 using the OVID interface
Search Details:
({perianal sepis.mp. AND magnestic resonance imaging.mp.} OR {perianal sepsis.mp. AND endosonography}).
Outcome:
8 articles. Only One non randomized prospective study comparing MRI and Endoanal sonography for evaluating perianal sepsis. Several reports about the role of MRI in evaluating perianal sepsis. A couple of reports quoting early experiences with perianal sepsis.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Evaluation of perianal sepsis: comparison of anal endosonography and magnetic resonance imaging Maier AG, Funovics MA and Kreuzer SH et al 2001, Austria | Patients presenting with perianal fistulae and sepsis investigated either with anal endosongraphy or magnetic resonance imaging. Findings compared at surgery | Prospective, non randomized | Diagnostic yeild of MRI and Anal Endosonography in the assessment of perianal abscesses and fistualae | MRI appears to be more specific and sensitive in the assessment of fistulous tracks in perianal sepsis | 1.Non randomized 2.Level of expertise of person performing anal endosongraphy not mentioned, this could have biased the results in favour of MRI |
Author Commentary:
There are no randomized trials comparing MRI and anal endosonography.
Bottom Line:
The current evidence supports MRI as the most accurate investigation for evaluating fistulous tracks in perianal sepsis.
References:
- Maier AG, Funovics MA and Kreuzer SH et al. Evaluation of perianal sepsis: comparison of anal endosonography and magnetic resonance imaging