P096 Transperineal ultrasound: first level exam in the management of perianal disease?
F. Terracciano*, G. Scalisi, F. Bossa, G. Biscaglia, D. Scimeca, M. Mangiacotti, M. R. Valvano, F. Perri. A. Andriulli
IRCCS Casa Sollievo della Sofferenza, Gastroenterology, San Giovanni Rotondo, Italy
Pelvic magnetic resonance imaging (MRI) has become the method of choice for evaluating perianal fistulae and abscesses in patients with inflammatory bowel diseases (IBD). Recently, transperinealultrasound (TPUS) has been proposed has a simple, safe and useful diagnostic tecnique to assess different pathological conditions of the pelvic floor including perineal disease in IBD patients.
Aim of this prospective single center study was to evaluate the accuracy of TPUS versus MRI for the detection and classification of perineal fistulae in IBD patients.
Twenty-eight consecutive IBD patients (17 males, mean age 37,6 ± 16 years) with known or suspected diagnosis of perineal disease were enrolled from November 2013 to November 2014. All patient underwent both TPUS and MRI within 30 days (median ). Fistulae and abscesses were classified according to the classification of Parks and the American Gastroenterological Association (AGA) Technical Review Panel. Concordance between the two techniques was assessed by k statistics.
Overall, 33 fistulae (4 superficial, 13 intersphinteric, 8 transphinteric, 2 extrasphinteric and 6 rectovaginal) and 8 abscesses were recognized (1 large and horseshoe-shaped, 2 large deep, 5 small and superficial) on TPUS. Conversely MRI identified 30 fistulae (7 superficial, 11 intersphinteric, 8 transphinteric, 1 extrasphinteric and 3 rectovaginal) and 8 abscess (1 large horseshoe-shaped, 2 large and deep, 3 small and deep, 1 superficial). Two rectovaginal, one intersphinteric and one transphinteric fistulae, and four small and superficial abscessess were not detected on MRI; while one intersphinteric fistula, three small and deep abscesses were not detected on TPUS. The agreement between TPUS and MRI for classyfing perianal fistulae was 75% according to Parks' classification (k = 0,67) and 92% according to AGA classification (k = 0,92).
TPUS is a simple and accurate diagnostic method for classifyng perineal fistulae, especially according AGA classification, and for detecting superficial and small abscesses in IBD patients. Being painless, easily repeatable and cheap method, it could be used in conbination with MRI to evaluate IBD patients with complicated perinel disease.