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Anovaginal and Rectovaginal Fistulas

Endoluminal Sonography Versus Endoluminal MR Imaging

¹ Department of Radiology, Academic Medical Center, University of Amsterdam, P. O. Box 22700, 1100 DE Amsterdam, The Netherlands.
² Department of Radiology, University Hospital Rotterdam Dijkzigt, Erasmus Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
³ Department of Surgery, University Hospital Rotterdam Dijkzigt, Erasmus Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands.

OBJECTIVE. The exact location of anovaginal and rectovaginal fistulas cannot be determined by physical examination and conventional techniques. The objective of our study was to compare the accuracy of endoluminal sonography and endoluminal MR imaging in revealing the location of anovaginal and rectovaginal fistulas.

MATERIALS AND METHODS. Nineteen consecutive patients (age range, 28-56 years; median age, 39 years) with clinical indications of an anovaginal or rectovaginal fistula were included in our retrospective study. Endoluminal sonography was performed using a 7.5-MHz transducer. Endoluminal MR imaging was performed at 0.5 T for 10 patients and 1.5 T for nine patients; axial T2-weighted gradient-echo, coronal and sagittal T2-weighted turbo spin-echo (0.5 T), or axial and radial T2-weighted turbo spin-echo and axial T2-weighted fatsaturated turbo spin-echo (1.5 T) images were obtained. For a variety of reasons, surgery of the fistula was not attempted in six of these 19 patients. The imaging findings were compared with the findings obtained during surgery in the remaining 13 patients.

RESULTS. In 12 of the 13 patients, the fistula was found during surgery: seven of the fistulas were anovaginal, and five were rectovaginal. Findings of endoluminal sonography were true-positive in 11 patients, true-negative in one, and false-negative in one. Findings of endoluminal MR imaging were true-positive in 11 patients, false-negative in one, and false-positive in one. Positive predictive value for endoluminal sonography and endoluminal MR imaging were 100% and 92%, respectively. Imaging findings for anal sphincter defects were comparable.

CONCLUSION. Endoluminal sonography and endoluminal MR imaging have comparable positive predictive values in revealing the location of anovaginal and rectovaginal fistulas.

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