MRI Imaging of Peri-anal Fistula.
Dr. Abd Allah Nazeer. MD.
Normal MR anatomy of the anal canal
Grade 1 Simple Inter-sphincteric Fistula
Grade 2 Inter-sphincteric track with
secondary track or abscess
Grade 3 Trans-sphincteric Fistula
Grade 4 Trans-sphincteric Fistula With
Abscess or Secondary Track
Grade 5 Supralevator and Translevator Disease
Majority (50%) of patients with
idiopathic peri-anal fistulation have
uncomplicated disease
25% have trans-sphincteric fis...
Grade 1- Intersphincteric fistula.
Grade 1- Intersphincteric fistula.
Axial T2-weighted images with fat suppression (STIR)
at two different levels (a, b). The dotted arrows
demonstrate the int...
Grade 1- Intersphincteric fistula.
Grade 1- Intersphincteric fistula.
Grade 2- Inter-sphincteric fistula with
collection or secondary tract.
Grade 3- Trans-sphincteric fistula.
Grade 3- Trans-
sphincteric
fistula.
Grade 3-
Trans-
sphincteric
fistula.
Grade 3-
Trans-
sphincteric
fistula.
Grade 3-
Trans-
sphincteric
fistula.
Grade 3- Trans-sphincteric fistula.
Grade 4- Trans-sphincteric fistula with secondary
track or abscess formation.
Grade 4- Trans-sphincteric fistula.
Trans-sphenteric fistula with abscess formation.
Trans-sphenteric fistula with abscess formation.
Grade 5- Translevator disease.
Grade 5- Translevator disease.
Grade 5 :
supralevator & translevator fistula
Left supra-levator abscess with inflammatory changes
at the left obturator muscle and extension to the
ischiorectal fossa.
Complex fistula
Horseshoe
fistula with
abscess
formation at
ischio-rectal
and ischio-anal
fossa.
Differential diagnosis
Sinus pilonidalis
On the left an example of a sinus pilonidalis.
There is a small abscess just abov...
Proctitis
On the left images of a patient who presented with anal
complaints.
No fistula was seen.
There is, however, a di...
Abscess in the Ischioanal space
An abscess in the ischioanal space with
no connection to the sphincter complex
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
Presentation2.pptx  peri anal fistula
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Presentation2.pptx peri anal fistula

  1. 1. MRI Imaging of Peri-anal Fistula. Dr. Abd Allah Nazeer. MD.
  2. 2. Normal MR anatomy of the anal canal
  3. 3. Grade 1 Simple Inter-sphincteric Fistula
  4. 4. Grade 2 Inter-sphincteric track with secondary track or abscess
  5. 5. Grade 3 Trans-sphincteric Fistula
  6. 6. Grade 4 Trans-sphincteric Fistula With Abscess or Secondary Track
  7. 7. Grade 5 Supralevator and Translevator Disease
  8. 8. Majority (50%) of patients with idiopathic peri-anal fistulation have uncomplicated disease 25% have trans-sphincteric fistulae complicated by secondary tracks or ischiorectal abscess Supra-levator or trans-levator disease is relatively rare in this patient group (8%).
  9. 9. Grade 1- Intersphincteric fistula.
  10. 10. Grade 1- Intersphincteric fistula.
  11. 11. Axial T2-weighted images with fat suppression (STIR) at two different levels (a, b). The dotted arrows demonstrate the inter-sphincteric fistula and its extension to the skin (solid arrow)
  12. 12. Grade 1- Intersphincteric fistula.
  13. 13. Grade 1- Intersphincteric fistula.
  14. 14. Grade 2- Inter-sphincteric fistula with collection or secondary tract.
  15. 15. Grade 3- Trans-sphincteric fistula.
  16. 16. Grade 3- Trans- sphincteric fistula.
  17. 17. Grade 3- Trans- sphincteric fistula.
  18. 18. Grade 3- Trans- sphincteric fistula.
  19. 19. Grade 3- Trans- sphincteric fistula.
  20. 20. Grade 3- Trans-sphincteric fistula.
  21. 21. Grade 4- Trans-sphincteric fistula with secondary track or abscess formation.
  22. 22. Grade 4- Trans-sphincteric fistula.
  23. 23. Trans-sphenteric fistula with abscess formation.
  24. 24. Trans-sphenteric fistula with abscess formation.
  25. 25. Grade 5- Translevator disease.
  26. 26. Grade 5- Translevator disease.
  27. 27. Grade 5 : supralevator & translevator fistula
  28. 28. Left supra-levator abscess with inflammatory changes at the left obturator muscle and extension to the ischiorectal fossa.
  29. 29. Complex fistula
  30. 30. Horseshoe fistula with abscess formation at ischio-rectal and ischio-anal fossa.
  31. 31. Differential diagnosis Sinus pilonidalis On the left an example of a sinus pilonidalis. There is a small abscess just above the nates. There is no relation with the sphincter complex.
  32. 32. Proctitis On the left images of a patient who presented with anal complaints. No fistula was seen. There is, however, a diffuse thickening of the rectal mucosa due to a proctitis.
  33. 33. Abscess in the Ischioanal space An abscess in the ischioanal space with no connection to the sphincter complex
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