Preoperative MRI of perianal fistula: is it really indispensable? Can it be deceptive?

The study aims not only to determine the value of preoperative MRI of perianal fistula but also to detect MRI fallacious results, if any. Also, it aims to suggest how we can limit such false positive MRI results that may lead to unnecessary surgery. This was a prospective comparative study, included 100 patients. Fifty of them [group A] were operated following the guidance of preoperative MRI, while the other 50 patients [group B] directly operated without MRI. The study protocol was approved by the ethics committee in Al-Mana General Hospital. Group A: surgically proven 24 patients grade 1, 13 grade 2, 4 grade 3, 4 grade 4 and 3 grade 5. MRI grading was 26 grades I, 13 grade 2, 4 grade 3, 4 grade 4 and 3 grade 5. Two patients were false positive. Postoperative complications: 2 recurrences, 1 incontinence and 1 both recurrence and incontinence. Group B: surgically proven 22 patients grade 1, 11 Grade 2, 8 grade 3, 3 grade 4 and 3 grade 5. Clinical preoperative grading was 42 patients grade 1 and 8 grade 2. Three patients were false positive. Postoperative complications: 17 recurrence, 6 incontinence, 3 concomitant recurrence and incontinence. MRI is a very helpful tool of preoperative imaging of perianal fistula. Its fallacious preoperative positive results - that may lead to unnecessary surgeries - can be corrected by standardizing IV gadolinium contrast as routine protocols or using complementary Color Doppler US examination of the fistulous track

role of color doppler sonography in the diagnosis of testicular lesions

Testicular lesions are common clinical problems affecting males of all age groups. Forty patients with scrotal pain and/or scrotal swelling were examined with Grey Scale and Color Doppler Sonography of the scrotum. In acute testicular lesions, including testicular torsion [15%] and acute epididymo-orchitis [47.5%], Color Doppler Sonography was more sensitive than Grey Scale Sonography, reaching up to 100% sensitivity in differentiating the two conditions. In chronic testicular lesions, there was an overlap in the vascular pattern and Doppler indices between chronic inflammatory lesions [20%] and malignant lesions [12.5%], that limit the role of Color Doppler Sonography to differentiate between these lesions. In cases of testicular trauma [5%], Color Doppler Sonography was able to demonstrate uninterrupted blood supply and avascular nature of testicular contusion. Color Doppler Sonography was very accurate in the diagnosis of acute testicular lesions, while its role in chronic testicular swellings still in need of further research on large number of patients