RECTAL PERFLUBRON - NEW APPLICATION IN MRI OF PERIRECTAL FISTULAS

Purpose: Our goal was to determine the efficacy of MRI with rectal adm inistration of perflubron in the evaluation of perirectal and pelvic f istulae, with an emphasis on development of an improved method for fis tula visualization. Method: Fourteen pelvic and/or perirectal fistulae were evaluated in nine patients with MRI after the rectal administrat ion of 200 mi of perflubron. Images were reviewed by two independent r eaders and evaluated for the presence or absence of fistulae. Qualitat ive assessment was also performed, rating the examinations for the abi lity to visualize the fistulae. Comparison was made with the clinical examination and/or operative findings, as well as available preperflub ron imaging studies (CT = 10; fluoroscopy = 1; preperflubron MRI = 4). Results: MRI with rectal perflubron demonstrated all 14 fistulae (100 %), while preperflubron imaging demonstrated only 7 of 14 (50%) fistul ae (p less than or equal to 0.008, Wilcoxon signed rank test). In addi tion, MRI with perflubron resulted in significantly improved qualitati ve visualization of fistulae (overall very good rating versus poor rat ing for preperflubron imaging, p less than or equal to 0.006, Wilcoxon signed rank test). Conclusion: MRI with rectal perflubron is a superi or modality for imaging of fistulae, compared with conventional method s, since it allows a noninvasive means of demonstrating the presence o f a fistula as well as offers improved qualitative assessment of fistu lous disease.