The MR appearance of vaginal fistulas

OBJECTIVE. The aim of this study was to determine the accuracy of MR imaging in revealing complex vaginal fistulas. SUBJECTS AND METHODS. Fifteen patients with clinical symptoms of vaginal fistulas were examined with MR imaging, using a combination of T1-weighted, T2-weighted, and fast multiplanar inversion recovery sequences in the axial plane, along with T2-weighted and fast multiplanar inversion recovery sequences in the sagittal plane. Observers examined the scans for a fistula and any associated masses or collections. The MR findings were recorded with the observers unaware of the results of cystoscopy and sigmoidoscopy under anesthesia. The MR findings were correlated with examination under anesthesia. RESULTS. Vaginal fistulas were seen in ten patients. All fistulas were confirmed surgically. Of the five patients with no fistulas revealed on MR imaging, examination under anesthesia also revealed no fistulas in four. However, in the fifth patient, examination under anesthesia revealed an epithelialized track, which was not seen on MR imaging. CONCLUSION. MR imaging was accurate in revealing and delineating the extent of vaginal fistulas in patients with clinical symptoms of such fistulas.