MRI FISTULOGRAM

An MRI scan Fistulogram is a particular type of MRI scan performed for the evaluation of perianal, rectal or other soft tissue fistulas. It captures the fistulous tract, its abscess cavities and any secondary extensions in exquisite detail. An MRI is the most accurate method for imaging complex or recurrent surgically assessed fistulas. 

What is MRI Fistulogram Test? 

An MRI scan Fistulogram is performed without any incisions and involves the use of magnetic fields and radio waves to obtain images of the anal and perineal regions. Fistula tract depiction may be improved by pouring a limited volume of saline or gel into the external fistula orifice. 

Parameters Considered in MRI Fistulogram Test

• A sequential slice T1-weighted imaging and T2 sequencing. 
• Fat suppressed plus STIR pictures. 
• Axial cuts plus sagittal and coronal view cuts. 
• Post contrast images (if used), 
• 3D imaging to view the tract in question. 

Reasons for the Test

• Recurrent perianal abscess or anal discharge. 
• Evaluation before surgery of fistula for surgical repair. 
• Evaluation after surgery of suspected complicated fistula surgery. 
• Assess internal openings of complex tracts in Crohn’s disease. 
• Evaluation of multiple tracts. 

When and Who Needs a Fistulogram MRI Scan? 

Indications: 

• Perianal fistula suspicious or confirmed 
• Crohn’s disease patients with perianal manifestations. 
• complicated or recurring anal fistulas 
• Previous surgery has not resolved the issue. 
• Accompanied perianal pain, discharge or swelling. 

Broad Patient Group: 

• Patients with advanced chronic perianal infections or discharges. 
• Crohn’s disease patients. 
• Follow up surgical patients. 
• Congenital anal fistula in children or adults. 

Benefits of MRI Fistulogram

• Precise mapping of the fistula. 
• Non-invasive procedure with high tissue detail. 
• Locates the internal openings and secondary tracts. 
• Assists with surgical planning and prevents recurrence. 

Diagnosed Conditions with Fistulogram MRI Scan

• Simple and complex perianal fistulas. 
• Trans-sphincteric or intersphincteric fistulas. 
• Suprasphincteric or extrasphincteric tracts. 
• Perianal abscesses. 
• Fistulas associated with Crohn’s disease. 
• Congenital fistulous tracts. 

Preparation for Fistulogram MRI Scan

• No solid prep unless instructed otherwise. 
• Surgical cleanse of the perianal area. 
• Enema is optional for some patients. 
• Pre-screen for allergy or history of implanted devices. 

Pre-requisites 

• Patient’s clinical summary with the attending physician's orders. 
• Intrafistular gel injection consent (if needed). 
• Renal function evaluation in the presence of contrast. 

Best Time to Perform an MRI Fistulogram 

• Prior to surgical correction of the fistula. 
• For recurrent or indeterminate perianal symptoms. 
• For managing Crohn’s disease. 

Eligibility for MRI Fistulogram Test 

• Most patients are covered. 
• Not for those with implants non-compatible with MRIs. 
• Claustrophobic patients may require sedatives. 

Fistulogram MRI Scan Procedure 

• Patient positioned prone (face down) or lateral decubitus (side). 
• Introduction of gel or saline into the fistula may be done. 
• MRI sequences completed in all required angles. 
• Contrast may be provided if inflammation or abscess is suspected. 
• Time: 30–45 minutes 
• Patient is free to resume daily activities immediately after. 

Caution 

• Scan procedure: Remain motionless for the duration of the scan 
• Inform the radiology technologist immediately upon feeling any pain or discomfort. Alert the technologist to any pain/discomfort experienced during the imaging course. 
• Patients with renal impairment should avoid the use of contrast.