Diffusion-weighted MRI for evaluating perianal fistula activity: Feasibility study

Purpose: To assess the feasibility of using diffusion-weighted magnetic resonance (MR) imaging (DWI) for evaluating perianal fistula activity. Materials and methods: This study retrospectively assessed 24 patients with clinically suspected perianal fistula who underwent a total of 28 MR examinations after conservative treatment with antibiotics. DWI was performed at 1.5 T, using b-values of 0 and 1000s/mm(2). Apparent diffusion coefficient (ADC) maps were created and ADCs of the lesions were measured. Lesions were classified into two groups based on the need for surgery and surgical findings: positive inflammation activity (PIA) and negative inflammation activity (NIA). ADCs of both groups were compared using an unpaired t-test, and Receiver Operating Characteristic (ROC) analysis was performed. Results: The ADC (in 10-3mm(2)/s) of the PIA group (0.908+/-0.171) was significantly lower (P = 0.0019) than that of the NIA group (1.124+/-0.244). The area under the ROC curve was 0.749. An optimal cut-off ADC of 1.109 yielded a sensitivity of 95.7%, a specificity of 50%, a positive predictive value of 71%, and a negative predictive value of 90%. Conclusion: DWI is a feasible method for evaluating perianal fistula activity. The diagnostic performance of this technique should be established in future, larger prospective studies. (C) 2011 Elsevier Ireland Ltd. All rights reserved.