Using MRI to guide surgical strategy for perianal fistulas: from conventional acquisition to 3D modeling

TL;DR

MRI helps surgeons plan better treatments for perianal fistulas by providing detailed imaging and 3D models.

Contribution

The paper highlights the role of 3D modeling derived from MRI in improving surgical planning for perianal fistulas.

Findings

MRI is the gold standard for evaluating perianal fistulas and guiding surgical decisions.

3D modeling from MRI data can enhance spatial understanding and surgical outcomes.

Accurate 3D models require precise image segmentation by experienced radiologists.

Abstract

Magnetic resonance imaging (MRI) is the gold-standard imaging modality for
evaluating perianal fistulas, playing a pivotal role in characterizing fistula
anatomy and guiding optimal surgical strategies. Appropriate preoperative MRI
assessment can significantly reduce recurrence rates and minimize the risk of
complications, such as fecal incontinence. This article reviews the most
relevant information that an MRI report should contain to aid effective surgical
decision-making for perianal fistulas. These features influence therapeutic
choices, including decisions regarding the suitability of techniques like
fistulotomy, ligation of the intersphincteric fistula tract (LIFT),
video-assisted anal fistula treatment (VAAFT), fistula-tract laser closure
(FiLaC), and advancement flaps. The emerging role of three-dimensional (3D)
modeling from MRI data is also discussed, highlighting its potential to enhance
surgeons’ spatial understanding of complex fistulous anatomy, thereby improving
surgical planning, reducing operative time, and ultimately improving outcomes.
However, the generation of accurate 3D models depends on meticulous image
segmentation and interpretation by experienced radiologists. Future research
directions, including the integration of 3D models with intraoperative
navigation and standardized assessment of inflammatory activity, are also
addressed in this review.

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