Added value of diffusion-weighted magnetic resonance imaging for the diagnosis of perianal fistula

Purpose: To evaluate the added value of diffusion-weighted (DWI) magnetic resonance imaging (MRI) by comparison with T2-weighted images alone in the diagnosis of perianal fistula. Material and methods: MRI examinations of 123 patients (97 men, 26 women; mean age, 41.9 years) with suspected perianal fistula were retrospectively evaluated by two radiologists. Fat-suppressed T2-weighted fast spin echo images, DWI (b values, 0 and 1000 s/mm(2)) and fat-suppressed gadolinium chelate-enhanced T1-weighted images were evaluated for each patient by using a four-point scale. Confidence scores and sensitivities were calculated for T2-weighted images alone, the combination of DWI and T2-weighted images and the combination of gadolinium chelate-enhanced T1-weighted images and T2-weighted images. The combination of gadolinium chelate-enhanced and T2-weighted images was used as reference standard. Results: Perianal fistulas were present in 92/123 patients (74.8%). An almost perfect inter-observer agreement was found for T2-weighted images (kappa = 0.868), the combination of gadolinium chelate-enhanced T1-weighted images and T2-weighted images (kappa = 0.96) and the combination of DWI and T2-weighted images (kappa = 0.90). The confidence scores for the diagnosis of perianal fistula for the combination of gadolinium chelate-enhanced T1-weighted images and T2- weighted images were greater than those of T2-weighted images alone for observer 1 (P < 0.001) and observer 2 (P = 0.009). The confidence scores of the combination of DWI and T2- weighted images were greater than those of T2-weighted images alone for observer 1 (P < 0.001) and observer 2 (P = 0.032). Sensitivity and specificity of the combination of DWI and T2-weighted images were greater than those of T2-weighted images alone for both observers. Conclusion: DWI has a significant added value compared to T2-weighted imaging alone in thediagnosis of perianal fistula. (C) 2016 Editions francaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.