Key Points
This chapter will detail the clinical utility of MRI of the anus. The main emphasis will be on fistula-in-ano, where MRI is extensively used because it is generally accepted to be the reference standard investigation, surpassing even surgical assessment. The pathogenesis of fistula-in-ano is described, along with the different types of fistula encountered and the principles of surgical treatment. We describe how fistula-in-ano may be imaged with MR and emphasize that precise Preoperative characterization of the anatomical course of the fistula and all associated infection is critical, if surgery is to be most effective. We also detail other clinical scenarios where MRI of the anus has particular clinical utility, namely investigation of anal incontinence and anal malignancy.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Beets-Tan RG, Beets GL, van der Hoop AG, et al (2001) Imaging of anal fistulas: does it really help the surgeon? Radiology 218:75–84
Bell SJ, Halligan S, Windsor ACJ, et al (2003) Response of fistulating Crohn's disease to infliximab treatment assessed by magnetic resonance imaging. Aliment Pharmacol Ther 17:387–393
Briel JW, Stoker J, Rociu E, et al (1999) External anal sphincter atrophy on endoanal magnetic resonance imaging adversely affects continence after sphincteroplasty. Br J Surg 86:1322–1327
Buchanan G, Halligan S, Bartram CI, et al (2004) Clinical examination, endosonography, and magnetic resonance imaging for preoperative assessment of fistula-in-ano: comparison to an outcome derived reference standard. Radiology 233:674–681
Buchanan G, Halligan S, Williams A, et al (2002) Effect of MRI on clinical outcome of recurrent fistula-in-ano. Lancet 360:1661–1662
Buchanan GN, Halligan S, Williams AB, et al (2003a) Magnetic resonance imaging for primary fistula in ano. Br J Surg 90:877–881
Buchanan GN, Williams AB, Bartram CI, et al (2003b) Potential clinical implications of direction of a trans-sphincteric anal fistula track. Br J Surg 90:1250–1255
Chiari H (1878) Uber die analen divertikel der rectum-schleimhaut und ihre beziehung zu den anal fisteln. Wien Med Press 19:1482–1483
deSouza NM, Gilderdale DJ, MacIver DK, et al (1997) High resolution MR imaging of the anal sphincter in children: a pilot study using endoanal receiver coils. AJR Am J Roentgenol 169:201–206
Dobben AC, Terra M P, Slors JF, et al (2007) External anal sphincter defects in patients with fecal incontinence: comparison of endoanal MR imaging and endoanal US. Radiology 242:463–471
Fucini C (1991) One stage treatment of anal abscesses and fistulae. Int J Colorect Dis 6:12–16
Halligan S, Bartram CI. (1998) MR imaging of fistula in ano: are endoanal coils the gold standard? AJR Am J Roentgenol 171:407–412
Halligan S, Buchanan G (2003) Imaging fistula-in-ano. Eur J Radiol 42:98–107
Halligan S, Stoker J (2006) Imaging fistula-in-ano: state-of-the-art. Radiology 239:18–33
Horsthuis K, Lavini C, Bipat S, et al (2009) Perianal Crohn disease: evaluation of dynamic contrast-enhanced MR imaging as an indicator of disease activity. Radiology 251:380–387
Hussain SM, Stoker J, Schouten WR, et al (1996) Fistula in ano: endoanal sonography versus endoanal MR imaging in classification. Radiology 200:475–481
Jarrett ME, Dudding TC, Nicholls RJ, et al (2008) Sacral nerve stimulation for fecal incontinence related to obstetric anal sphincter damage. Dis Colon Rectum 51:531–537
Koelbel G, Schmiedl U Majer MC, et al (1989) Diagnosis of fistulae and sinus tracts in patients with Crohn disease: value of MR imaging. Am J Roentgenol 152:999–1003
Koh DM, Dzik-Jurasz A, O'Neill B, et al (2008) Pelvic phasedarray MR imaging of anal carcinoma before and after chemoradiation. Br J Radiol 81:91–98
Law PJ, Bartram CI. (1989) Anal endosonography. Technique and normal anatomy. Gastrointest Radiol 14:349–353
Lilius HG (1968) Investigation of human foetal anal ducts and intramuscular glands and a clinical study of 150 patients. Acta Chir Scand Supp 383:88
Lunniss PJ, Armstrong P, Barker PG, et al (1992) Magnetic resonance imaging of anal fistulae. Lancet 340:394–396
Malouf AJ, Williams AB, Halligan S, et al (2000) Prospective assessment of accuracy of endoanal MR imaging and endosonography in patients with fecal incontinence. AJR Am J Roentgenol 175:741–745
Parks AG (1961) The pathogenesis and treatment of fistula-in-ano. Br Med J 5224:463–469
Parks AG, Gordon PH, Hardcastle JD (1976) A classification of fistula –in-ano. Br J Surg 63:1–12
Reay Jones NH, Healy JC, King LJ, et al (2003) Pelvic connective tissue resilience decreases with vaginal delivery, menopause and uterine prolapse. Br J Surg 90:466–467
Rociu E, Stoker J, Eijkemans MJ, et al (1999) Fecal incontinence: endoanal US versus endoanal MR imaging. Radiology 212:453–458
Sanio P (1984) Fistula-in-ano in a defined population: incidence and epidemiological aspects. Acta Chir Gynaecol 73:219–224
Schwartz DA, Loftus EV Jr, Tremaine WJ, et al (2002) The natural history of fistulizing Crohn's disease in Olmsted County, Minnesota. Gastroenterology 122:875–880
Schwartz DA, Wiersema MJ, Dudiak KM et al (2001) A comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluation of Crohn's perianal fistulas. Gastroenterology 121:1064–1072
Spencer JA, Chapple K, Wilson D, et al (1998) Outcome after surgery for perianal fistula: predictive value of MR imaging. AJR Am J Roentgenol 171:403–406
Spencer JA, Ward J, Beckingham IJ, Adams C, Ambrose NS (1996) Dynamic contrast-enhanced MR imaging of perianal fistulas. Am J Roentgenol 167:735–741
Sultan AH, Kamm MA, Hudson CN, et al (1993) Anal sphincter disruption during vaginal delivery. New Engl J Med 329:1905–1911
Taylor SA, Halligan S, Bartram CI (2003) Pilonidal sinus disease: MR imaging distinction from fistula in ano. Radiology 226:662–667
Terra MP, Beets-Tan RG, van Der Hulst V P, et al (2005) Anal sphincter defects in patients with fecal incontinence: endo-anal versus external phased-array MR imaging. Radiology 236:886–895
Terra MP, Beets-Tan RG, van der Hulst VP, et al (2006) MRI in evaluating atrophy of the external sphincter in patients with fecal incontinence. AJR Am J Roentgenol 187:991–999
Terra MP, Deutekom M, Beets-Tan RG, et al (2006) Relationship between external anal sphincter atrophy at endoanal magnetic resonance imaging and clinical, functional, and anatomic characteristics in patients with fecal incontinence. Dis Colon Rectum 49:668–678
Vaizey CJ, Kamm MA, Gold DM, et al (1998) Clinical, physiological, and radiological study of a new purpose-designed artificial bowel sphincter. Lancet 352:105–109
Williams AB, Bartram CI, Halligan S, et al (2001) Anal sphincter damage after vaginal delivery using three-dimensional endosonography. Obstet Gynecol 97(5 Pt 1):770
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2010 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Halligan, S., Taylor, S.A. (2010). MRI of the Anus. In: Stoker, J. (eds) MRI of the Gastrointestinal Tract. Medical Radiology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-85532-3_19
Download citation
DOI: https://doi.org/10.1007/978-3-540-85532-3_19
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-85531-6
Online ISBN: 978-3-540-85532-3
eBook Packages: MedicineMedicine (R0)