Role of magnetic resonance imaging in the assessment of perianal fistulas.

OBJECTIVE: This study was carried out to evaluate the role of magnetic resonance imaging (MRI) in preoperative assessment of fistula-in-ano. SUBJECTS AND METHODS: Twenty-six patients (21 male and 5 female, age 19-65 years) were prospectively studied from July 1999 to December 2001 using a 1.0-tesla superconducting magnet. T(1)-weighted fast spin echo (T1W FSE) images before and after gadolinium injection and fat suppressed T2-weighted fast spin echo (T2W FSE) images were obtained in transverse and coronal planes. MRI findings were correlated with surgical findings. RESULTS: Twenty-one of the 26 patients demonstrated active fistulas. The MRI findings were in accordance with the examination findings under anesthesia and/or surgery in 15 of 16 cases. Both coronal and transverse planes were useful in assessing the location and direction of tracts and abscesses. Both contrast-enhanced T1W FSE and fat-suppressed T2W FSE images were useful in assessing the activity of lesions and the course of tracts. CONCLUSION: MRI showed accurate correlation with surgical findings and aided in preoperative management and planning for surgery.

Diagnosis of gastro-oesophageal reflux in children. Comparison between oesophageal pH and barium examinations.

BACKGROUND: Gastro-oesophageal reflux (GOR) is a common disorder encountered during childhood. Early diagnosis and treatment is essential to prevent serious complications. There are several methods for the diagnosis of GOR, with variable opinions regarding which one is the most sensitive and specific. OBJECTIVE: This is a retrospective study comparing 24-h oesophageal pH monitoring and barium examinations in the diagnosis of GOR in children. Patients and methods. All children referred with signs and/or symptoms of GOR from January to December 1996 at Great Ormond Street Hospital, London, UK, were included in the study. The recorded results (presence or absence of reflux) of barium examinations and 24-h oesophageal pH monitoring studies performed on 169 children were retrospectively reviewed and compared. RESULTS: One-third of patients were below 1 year of age. In all age groups, oesophageal pH probe studies showed a high detection rate (83%) and low incidence of false-negative results (7%) compared to barium examinations, which showed a lower detection rate (43%) and higher incidence of false-negative results (48%). Most GOR-related anatomical abnormalities diagnosed by barium examinations were identified in infants below 1 year of age. CONCLUSIONS: We believe that 24-h oesophageal pH monitoring should be used as the first line of investigation for the diagnosis of GOR in all children regardless of the age group. Barium examinations can be reserved for patients below 1 year of age, those going for surgery and those with negative oesophageal pH monitoring results but strong clinical suspicion of GOR.