Role of MRI with endorectal coil in management of perianal fistula

Aim: the management of fistula in-ano has been based on digital examination and operative findings. This study was conducted to asses the diagnostic accuracy of magnetic resonance imaging [MRI] with endorectal coil in perianal fistula

Patients and Methods: twenty patients with anal fistula were classified into two groups. The first one included those who had primary fistula [10 patients] and the second included those with recurrent fistula [10 patients]. All patients underwent preoperative MR imaging using endorectal coil. The findings were compared to examination under anesthesia [ELIA] and final surgical findings

Results: comparing MRI with operative data [EUA and final surgical results]; in the first group with simple fistula, MR imaging showed additional information than examination under anesthesia in only one patient [10%] and did not diagnose one fistulous tract at all. 111 the second group, MRI detected 8 internal openings correctly and one opening was missed. MRI added information than EUA in 6 patients, its fallacies was noted in 2 patients

Conclusion: MRI with endorectal coil could be very useful and reliable in defining fistula anatomy, assessing relationship with anal sphincter, identifying secondary extensions [particularly horseshoe tracts] and planning surgical strategy

Adult intussusception: a clinical problem. How can CT scan solve it?

Abdominal CT scans in 11 adult in tussusceptions were analyzed. Patients were 8 males and 3 females. Their ages ranged from 18-53 years [mean age: 31.5 years]. All were clinically unsuspected and all were confirmed at surgery. In 9 of our 11 patients, there was organic lesion [benign or malignant tumor] while in 2 patients no cause was found at surgery and thus they were considered idiopathic. The surgical management in our cases involved 7 cases of right hemicolectomy, 2 cases of resection anastomosis and 2 cases of reduction and fixation. One of our cases was jejunoileal intussusception, two were ileoileal, 4 were ileocolic and 3 were colocolic. The last of our cases had synchronous multiple jejunojejunal and colocolic] intussusceptions. We reviewed the different reports about the CT findings in adult intussusception in order to put a spotlight on every sign of the disease and to define its significance. We found "target" mass in 5 cases, one of which showed intramural air crescent. "Layering" pattern was found in 3 cases. "Reniform" mass was seen in 2 cases and the last case showed a sausage shaped" mass. Five of our cases felt in stage [1] and 6 were of stage [2]. Our results suggest that the internal anatomical detail of the mass is more important in its staging than its overall shape. We concluded that not only is CT valuable in the diagnosis of adult intussusception but it is also more informative than other techniques. It can detect the early changes of vascular compromise which influences the surgical plan. Moreover, it can occasionally suggest the underlying organic cause of the disease

value of MR imaging of the bone marrow in children with haematopoietic malignancies

Malignancies were examined by MRI to detect the bone marrow changes. They were 44 patients with acute leukaemia, 4 patients with chronic myelogenous leukaemia, 4 patients with Hodgkins lymphoma, 3 patients with non. Hodgkin s lymphomta and 2 patients with polycythaemia vera. MRI proved to be highly sensitive in detection of focal or dtffuse bone marrow changes in 52 patients [Sensitivity: 100%] and to exclude any bone marrow affection in 5 patients [Specificity: 100%]. In spite of its high sensitivity in detection of bone marrow pathology, MRI could not defive a certain disease. In all haematopoietic malignancies, MRI revealed focal or diffuse low signal intensity on T1 -weighted images and high signal intensity on T2-weighted images. MRI-guided bone marrow biopsy was performed in 26 patients. All were successful and augmented the MRI diagnosis of persistence or relapse of the disease [19 patients], bone marrow aplation with fat replacement [4 patients] and secondary post therapy myelofibrosis [3 patients]. MR1 was proved to be very valuable tool in follow up of patients and in detection of the therapy complications. Its use should restrict the need for bone marrow biopsy to one time at the initial diagnosis