Non-contrast with contrast-enhanced three-dimensional endoanal ultrasound in preoperative assessment of anal fistula: A comparative study

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Abstract

Purpose: The purpose of this study was to compare the accuracy of non-contrast-enhanced three-dimensional endoanal ultrasound (NC-3D-EAS) with contrast-enhanced three-dimensional endoanal ultrasound (CE-3D-EAS) in pre-operative assessment of anal fistula. Materials and Methods: A total of 28 patients (30 primary tracts) with anal fistula underwent 3D-EAS assessments. Three-dimensional volume displays were acquired in 3 steps: before (NC-3D-EAS), immediately after (CE-3D-EAS) and 10 minutes after 3% hydrogen peroxide administration (delayed CE-3D-EAS). Fistula classification and the presence of internal opening were determined via NC-3D-EAS and CE-3D-EAS. The abscess cavity and secondary tract were determined using all 3 steps. The 3D-EAS findings were compared with surgical findings, which served as the reference standard. Results: CE-3D-EAS was found to be more accurate than NC-3D-EAS. In the classification of the primary tract, there was good agreement between the surgical finding and NC-3D-EAS (Kappa = 0.674), and very good agreement between the surgical finding and CE-3D-EAS (Kappa = 0.815). The sensitivity and specificity of NC-3D-EAS and CE-3D-EAS for detection of the internal opening were 75%, 81%, 95% and 91%, respectively. The sensitivity and specificity for NC-3D- EAS, CE-3D-EAS and delayed-CE-3D-EAS in the detection of abscess cavity were identical, at 95% and 91%, respectively. There were 6 secondary tracts detected on NC-3D-EAS but only 4 were seen in CE-3D-EAS and delayed CE-3D-EAS. The other two hypoechoic lines were perianal scarrings. Delayed CE-3D-EAS allowed for better delineation of the secondary tract. Conclusion: CE-3D-EAS increases the accuracy of pre-operative anal fistula assessment, particularly in recurrent or complex fistula. Delayed CE-3D-EAS provides extra information about the extension of the secondary tract by allowing more time for the tract to fill up with hydrogen peroxide.

Original languageEnglish
JournalBiomedical Imaging and Intervention Journal
Volume9
Issue number2
DOIs
Publication statusPublished - 2013

Fingerprint

Rectal Fistula
Hydrogen peroxide
Ultrasonics
Abscess
Hydrogen Peroxide
Fistula
Sensitivity and Specificity
Display devices
Cicatrix

Keywords

  • Abscess cavity
  • Anal fistula
  • Internal opening
  • Primary tract
  • Secondary tract
  • Three dimensional endoanal ultrasound (3D-EAS)

ASJC Scopus subject areas

  • Biomedical Engineering
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

@article{37dc09b1d39b4238a7c1101436440946,
title = "Non-contrast with contrast-enhanced three-dimensional endoanal ultrasound in preoperative assessment of anal fistula: A comparative study",
abstract = "Purpose: The purpose of this study was to compare the accuracy of non-contrast-enhanced three-dimensional endoanal ultrasound (NC-3D-EAS) with contrast-enhanced three-dimensional endoanal ultrasound (CE-3D-EAS) in pre-operative assessment of anal fistula. Materials and Methods: A total of 28 patients (30 primary tracts) with anal fistula underwent 3D-EAS assessments. Three-dimensional volume displays were acquired in 3 steps: before (NC-3D-EAS), immediately after (CE-3D-EAS) and 10 minutes after 3{\%} hydrogen peroxide administration (delayed CE-3D-EAS). Fistula classification and the presence of internal opening were determined via NC-3D-EAS and CE-3D-EAS. The abscess cavity and secondary tract were determined using all 3 steps. The 3D-EAS findings were compared with surgical findings, which served as the reference standard. Results: CE-3D-EAS was found to be more accurate than NC-3D-EAS. In the classification of the primary tract, there was good agreement between the surgical finding and NC-3D-EAS (Kappa = 0.674), and very good agreement between the surgical finding and CE-3D-EAS (Kappa = 0.815). The sensitivity and specificity of NC-3D-EAS and CE-3D-EAS for detection of the internal opening were 75{\%}, 81{\%}, 95{\%} and 91{\%}, respectively. The sensitivity and specificity for NC-3D- EAS, CE-3D-EAS and delayed-CE-3D-EAS in the detection of abscess cavity were identical, at 95{\%} and 91{\%}, respectively. There were 6 secondary tracts detected on NC-3D-EAS but only 4 were seen in CE-3D-EAS and delayed CE-3D-EAS. The other two hypoechoic lines were perianal scarrings. Delayed CE-3D-EAS allowed for better delineation of the secondary tract. Conclusion: CE-3D-EAS increases the accuracy of pre-operative anal fistula assessment, particularly in recurrent or complex fistula. Delayed CE-3D-EAS provides extra information about the extension of the secondary tract by allowing more time for the tract to fill up with hydrogen peroxide.",
keywords = "Abscess cavity, Anal fistula, Internal opening, Primary tract, Secondary tract, Three dimensional endoanal ultrasound (3D-EAS)",
author = "Low, {S. F.} and A. Maimunah and Osman, {Syazarina Sharis} and Ismail Sagap and {Abdul Hamid}, Hamzaini",
year = "2013",
doi = "10.2349/biij.9.2.e7",
language = "English",
volume = "9",
journal = "Biomedical Imaging and Intervention Journal",
issn = "1823-5530",
publisher = "University of Malaya",
number = "2",

}

TY - JOUR

T1 - Non-contrast with contrast-enhanced three-dimensional endoanal ultrasound in preoperative assessment of anal fistula

T2 - A comparative study

AU - Low, S. F.

AU - Maimunah, A.

AU - Osman, Syazarina Sharis

AU - Sagap, Ismail

AU - Abdul Hamid, Hamzaini

PY - 2013

Y1 - 2013

N2 - Purpose: The purpose of this study was to compare the accuracy of non-contrast-enhanced three-dimensional endoanal ultrasound (NC-3D-EAS) with contrast-enhanced three-dimensional endoanal ultrasound (CE-3D-EAS) in pre-operative assessment of anal fistula. Materials and Methods: A total of 28 patients (30 primary tracts) with anal fistula underwent 3D-EAS assessments. Three-dimensional volume displays were acquired in 3 steps: before (NC-3D-EAS), immediately after (CE-3D-EAS) and 10 minutes after 3% hydrogen peroxide administration (delayed CE-3D-EAS). Fistula classification and the presence of internal opening were determined via NC-3D-EAS and CE-3D-EAS. The abscess cavity and secondary tract were determined using all 3 steps. The 3D-EAS findings were compared with surgical findings, which served as the reference standard. Results: CE-3D-EAS was found to be more accurate than NC-3D-EAS. In the classification of the primary tract, there was good agreement between the surgical finding and NC-3D-EAS (Kappa = 0.674), and very good agreement between the surgical finding and CE-3D-EAS (Kappa = 0.815). The sensitivity and specificity of NC-3D-EAS and CE-3D-EAS for detection of the internal opening were 75%, 81%, 95% and 91%, respectively. The sensitivity and specificity for NC-3D- EAS, CE-3D-EAS and delayed-CE-3D-EAS in the detection of abscess cavity were identical, at 95% and 91%, respectively. There were 6 secondary tracts detected on NC-3D-EAS but only 4 were seen in CE-3D-EAS and delayed CE-3D-EAS. The other two hypoechoic lines were perianal scarrings. Delayed CE-3D-EAS allowed for better delineation of the secondary tract. Conclusion: CE-3D-EAS increases the accuracy of pre-operative anal fistula assessment, particularly in recurrent or complex fistula. Delayed CE-3D-EAS provides extra information about the extension of the secondary tract by allowing more time for the tract to fill up with hydrogen peroxide.

AB - Purpose: The purpose of this study was to compare the accuracy of non-contrast-enhanced three-dimensional endoanal ultrasound (NC-3D-EAS) with contrast-enhanced three-dimensional endoanal ultrasound (CE-3D-EAS) in pre-operative assessment of anal fistula. Materials and Methods: A total of 28 patients (30 primary tracts) with anal fistula underwent 3D-EAS assessments. Three-dimensional volume displays were acquired in 3 steps: before (NC-3D-EAS), immediately after (CE-3D-EAS) and 10 minutes after 3% hydrogen peroxide administration (delayed CE-3D-EAS). Fistula classification and the presence of internal opening were determined via NC-3D-EAS and CE-3D-EAS. The abscess cavity and secondary tract were determined using all 3 steps. The 3D-EAS findings were compared with surgical findings, which served as the reference standard. Results: CE-3D-EAS was found to be more accurate than NC-3D-EAS. In the classification of the primary tract, there was good agreement between the surgical finding and NC-3D-EAS (Kappa = 0.674), and very good agreement between the surgical finding and CE-3D-EAS (Kappa = 0.815). The sensitivity and specificity of NC-3D-EAS and CE-3D-EAS for detection of the internal opening were 75%, 81%, 95% and 91%, respectively. The sensitivity and specificity for NC-3D- EAS, CE-3D-EAS and delayed-CE-3D-EAS in the detection of abscess cavity were identical, at 95% and 91%, respectively. There were 6 secondary tracts detected on NC-3D-EAS but only 4 were seen in CE-3D-EAS and delayed CE-3D-EAS. The other two hypoechoic lines were perianal scarrings. Delayed CE-3D-EAS allowed for better delineation of the secondary tract. Conclusion: CE-3D-EAS increases the accuracy of pre-operative anal fistula assessment, particularly in recurrent or complex fistula. Delayed CE-3D-EAS provides extra information about the extension of the secondary tract by allowing more time for the tract to fill up with hydrogen peroxide.

KW - Abscess cavity

KW - Anal fistula

KW - Internal opening

KW - Primary tract

KW - Secondary tract

KW - Three dimensional endoanal ultrasound (3D-EAS)

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U2 - 10.2349/biij.9.2.e7

DO - 10.2349/biij.9.2.e7

M3 - Article

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VL - 9

JO - Biomedical Imaging and Intervention Journal

JF - Biomedical Imaging and Intervention Journal

SN - 1823-5530

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