Role Of Transcutaneous Perianal Ultrasonography In Grading Of Patients With Perianal Fistula According To Garg (2017) & St James Grading Systems In Correlation With Magnetic Resonance Imaging

Abstract

Background: Trans-perineal ultrasound (TPUS) is a dynamic diagnostic technique for assessment of the perianal region for evaluating fistulas and abscesses. Magnetic resonance imaging (MRI) is considered the modality of choice in evaluation of perianal fistula, especially in cases of perianal fistulae. The aim of this work was to assess the role of TPUS in grading perianal fistula according to St James & Garg grading system and to correlate the findings with MRI as gold standard. Methods:This prospective clinical study was carried out on 25 patients, aged from 17 to 68 years, both sexes, with clinical criteria of clinical suspicion of perianal fistula, primary and recurrent cases.All patients underwent TPUS and then MRI. The time interval between TPUS and MRI examinations was less than fourteen days. Results: The different values of Garg grades detected by TPUS plotted against those detected by MRI, we found that TPUS had moderate agreement with MRI (kappa = 0.61 and P value <0.001). There is higher agreement between TPUS and MRI using this system (kappa = 0.67and P value < 0.001). Conclusions:TPUS had moderate agreement with MRI (kappa agreement about 0.61) and high statistical significance. There was higher agreement between TPUS and MRI using this system where kappa agreement was 0.67 with high statistical significance. Speaking about the new classification that was approved in 2017 by Garg, the most common fistula type was grade I by both TPUS and MRI happened in 11 patients 44% by TPUS and 9 patients 36% by MRI.