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Background <p>Perianal inflammatory diseases represent up to 5% of proctology consultations. Trans-perineal ultrasound (TPUS) offers a dynamic, non-invasive technique for evaluating the perianal region.</p> <p>This prospective study included 55 patients with suspected perianal inflammatory disease. All patients underwent trans-perineal ultrasound (TPUS) followed by MRI. Patient demographics, imaging findings, and operative results were analyzed. A new classification approach was applied using TPUS, incorporating the Standard Practice Task Force (SPTF) classification, the St. James’s University Hospital grading system, and the internal opening position, rather than the traditional Parks classification. The diagnostic performance of TPUS in classifying fistulas (its sensitivity, specificity, and accuracy) was assessed in comparison to MRI and surgical findings.</p> Results <p>This study included 55 patients presenting with perianal inflammatory complaints. Perianal fistulas were observed in 47 cases (85.5%), while sinuses were identified in 8 cases (14.5%). All perianal fistulas were classified using various classification systems for comparison. According to the St. James’s University Hospital grading system via TPUS, Grade 1 was the most prevalent, observed in 38.3% of cases. In the SPTF classification, simple tracts were identified in 57.4% of cases, and based on the position of the internal opening, low fistulas were observed in 76.6% of cases.</p> <p>The sensitivity, specificity, and accuracy of TPUS in classifying fistulas based on the St. James’s University Hospital and SPTF classifications were 80.9% (95% CI:66.7%-90.9%), 100% (95% CI: 63.1%-100%), and 83.6% (95% CI: 69.9%-92.8%), respectively, showing a statistically significant difference compared to MRI (<i>p</i> = 0.003). However, there was no statistically significant concordance between TPUS and MRI in detecting the internal opening (<i>p</i> = 0.05).</p> Conclusion <p>TPUS proved effective in detecting and classifying simple perianal fistulas and sinuses, with advantages in cost, accessibility, and patient comfort, making it suitable as a first-line tool, especially in emergencies or resource-limited settings. However, due to limitations in complex or high fistulas, a hybrid imaging strategy incorporating MRI remains essential for accurate diagnosis and surgical planning.</p>

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Detection and classification of perianal inflammatory diseases: precision of preoperative Trans perineal Ultrasonography

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月29日

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  • Manar M. Sayed,
  • Shehab Gamal El Deen Ahmed,
  • Nadia F. El Ameen,
  • Ehab Ali Abdelgawad,
  • Mohamed Ahmed Abdelsamie,
  • Christina M. Kamil

摘要

Background

Perianal inflammatory diseases represent up to 5% of proctology consultations. Trans-perineal ultrasound (TPUS) offers a dynamic, non-invasive technique for evaluating the perianal region.

This prospective study included 55 patients with suspected perianal inflammatory disease. All patients underwent trans-perineal ultrasound (TPUS) followed by MRI. Patient demographics, imaging findings, and operative results were analyzed. A new classification approach was applied using TPUS, incorporating the Standard Practice Task Force (SPTF) classification, the St. James’s University Hospital grading system, and the internal opening position, rather than the traditional Parks classification. The diagnostic performance of TPUS in classifying fistulas (its sensitivity, specificity, and accuracy) was assessed in comparison to MRI and surgical findings.

Results

This study included 55 patients presenting with perianal inflammatory complaints. Perianal fistulas were observed in 47 cases (85.5%), while sinuses were identified in 8 cases (14.5%). All perianal fistulas were classified using various classification systems for comparison. According to the St. James’s University Hospital grading system via TPUS, Grade 1 was the most prevalent, observed in 38.3% of cases. In the SPTF classification, simple tracts were identified in 57.4% of cases, and based on the position of the internal opening, low fistulas were observed in 76.6% of cases.

The sensitivity, specificity, and accuracy of TPUS in classifying fistulas based on the St. James’s University Hospital and SPTF classifications were 80.9% (95% CI:66.7%-90.9%), 100% (95% CI: 63.1%-100%), and 83.6% (95% CI: 69.9%-92.8%), respectively, showing a statistically significant difference compared to MRI (p = 0.003). However, there was no statistically significant concordance between TPUS and MRI in detecting the internal opening (p = 0.05).

Conclusion

TPUS proved effective in detecting and classifying simple perianal fistulas and sinuses, with advantages in cost, accessibility, and patient comfort, making it suitable as a first-line tool, especially in emergencies or resource-limited settings. However, due to limitations in complex or high fistulas, a hybrid imaging strategy incorporating MRI remains essential for accurate diagnosis and surgical planning.