Document Detail

A Diagnostic Accuracy Meta-analysis of Endoanal Ultrasound and MRI for Perianal Fistula Assessment.
MedLine Citation:
PMID:  22513437     Owner:  NLM     Status:  In-Data-Review    
BACKGROUND: : Imaging modalities such as endoanal ultrasound or MRI can be useful preoperative adjuncts before the appropriate surgical intervention for perianal fistulas.
OBJECTIVES: : We present a systematic review of published literature comparing endoanal ultrasound with MRI for the assessment of idiopathic and Crohn's perianal fistulas.
DESIGN: : A meta-analysis was performed to obtain pooled values for specificity and sensitivity.
SETTINGS: : Electronic databases were searched from January 1970 to October 2010 for published studies.
PATIENTS AND INTERVENTIONS: : Four studies were used in our analysis. There were 241 fistulas in the ultrasound group and 240 in the magnetic resonance group.
RESULTS: : The combined sensitivity and specificity of magnetic resonance for fistula detection were 0.87 (95% CI: 0.63-0.96) and 0.69 (95% CI: 0.51-0.82). There was a high degree of heterogeneity between studies reporting on MRI sensitivity (df = 3, I = 93%). This compares to a sensitivity and specificity for endoanal ultrasound of 0.87 (95% CI: 0.70-0.95) and 0.43 (95% CI: 0.21-0.69). There was a high degree of heterogeneity between studies reporting on endoanal ultrasound sensitivity (df = 3, I = 92%).
CONCLUSIONS: : From the available literature, the summarized performance characteristics for MRI and endoanal ultrasound demonstrate comparable sensitivities at detecting perianal fistulas, although the specificity for MRI was higher than that for endoanal ultrasound. Both specificity values are considered to be diagnostically poor, however. The high degree of data heterogeneity and the shortage of applicable studies precludes any firm conclusions being made for clinical practice. Future trials with improved study design (including prospective data collection and consideration of verification bias) may help to further clarify the role of MRI in the assessment and treatment response monitoring of perianal fistulas (particularly in patients with Crohn's disease).
Muhammed R S Siddiqui; Hutan Ashrafian; Phil Tozer; Najib Daulatzai; David Burling; Ailsa Hart; Thanos Athanasiou; Robin K Phillips
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Diseases of the colon and rectum     Volume:  55     ISSN:  1530-0358     ISO Abbreviation:  Dis. Colon Rectum     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-04-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372764     Medline TA:  Dis Colon Rectum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  576-85     Citation Subset:  IM    
1St. Mark's Institute, Harrow, United Kingdom 2Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
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