الفهرس 
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Abstract
Background: Perianal fistula is a rather common disease; its symptoms range from mild to severe, impairing anal continence; accurate preoperative evaluation avoids recurrence following surgical procedures.
Aim of work: Our study examined the diagnostic accuracy of magnetic resonance imaging with direct percutaneous instillation of hydrogen peroxide mixed with gadolinium (Direct fistulography) in comparison to intravenous gadolinium contrast-enhanced study (indirect fistulography).
Methods: This prospective study was conducted on patients referred to Airforce hospital radiology department and were diagnosed with perianal fistula, Direct and indirect MR fistulography were performed using a 1.5T MRI scanner. The type of fistulae, internal openings, secondary branches, and abscesses were compared to surgical findings.
The result: Our study included 35 male patients. Both direct and indirect methods detected primary tracts with 97.1% sensitivity and accuracy rates of 91.9% and 89.2%, respectively. The direct method was superior in detecting secondary branches and internal openings with accuracy rates of 97.37% and 93.3%, respectively, compared to 86.8 % and 86.6% for the indirect method, while the indirect method was superior in detecting abscess collections with 100% accuracy rate compared to 89.2% accuracy rate for the direct method. None of the patients reported fever or bleeding after the procedure.
Conclusions: Both direct and indirect fistulography showed comparable abilities in detecting primary fistulous tracts. However, the direct fistulography was superior in detecting internal openings and secondary tracts particularly in chronic cases , whereas indirect Fistulography was superior in detecting abscess collections. Incorporating both methods into our routine could thus improve the efficacy of surgical procedures.