Alice Arcidiacono, Presenter: Nothing to Disclose

Francesca Nosenzo, Abstract Co-Author: Nothing to Disclose

Angelo Corazza MD, Abstract Co-Author: Nothing to Disclose

Silvia Perugin Bernardi MChir, Abstract Co-Author: Nothing to Disclose

Giovanni Turtulici, Abstract Co-Author: Nothing to Disclose

Enzo Silvestri MD, Abstract Co-Author: Nothing to Disclose

The aim of our study is to compare the accuracy and sensitivity of standard non contrast ultrasonography (US) with contrast-enhanced ultrasonography (CEUS) in the diagnosis of anal fistulas.Because current imaging techniques tend to underestimate the extent, location and course of perianal fistulas, crucial information for surgical planning, we evaluated whether transperineal and endoanal CEUS significantly improves their characterization compared with non-contrast US

15 patients (10 male, 5 female; mean age 50 ± 10 yrs) with clinical diagnosis of perianal fistula, with visible external opening, were examinated by performing US and CEUS, with both 7-12 Mhz linear probe and 5-9 Mhz endocavital probe. After non-contrast US, 4.8 ml of Bracco Sonovue with 20 cc of saline solution was injected in the cannulated fistula and US examination was repeated. In all patients we identify the type, the complexity and the entire course of anal fistulas (including their relation to the internal and external sphincters and the levator ani muscle), as well as the location of the internal openings.This depiction of fistulas permits an accurate classification, which facilitates surgical planning

All fistulas were identified by non-contrast and contrast-enhanced endoanal and transperineal US. The US findings have been confirmed intraoperatively. Results showed that CEUS was more sensitive in diagnosing the type of anal fistulas than non-contrast US giving more detailed information about the location of the fistula in relation to the anal lumen and sphincters; moreover, CEUS showed higher sensitivity than non-contrast US in demonstrating internal openings (100% and 87% respectively).

The application of transperineal and endoanal CEUS was found to be a useful technique for documentation of the presence, number, anatomotopographic localization and internal course of perianal fistulas and for characterization of abnormalities not adequately seen at non-contrast US. In addition, the technique permitted surgeons to stratify patients into treatment groups so it has been especially useful for planning surgical treatments.

The application of endoanal and transperineal CEUS offers a more detailed perianal fistulas imaging than standard non-contrast US, being very useful for surgical planning.

Arcidiacono, A, Nosenzo, F, Corazza, A, Perugin Bernardi, S, Turtulici, G, Silvestri, E, The Use of Contrast-enhanced Transperineal and Endoanal Ultrasonography in the Management of Perianal Fistulas.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13028435.html