 Hello everyone, I am Dr. Anur Varma, junior resident in the biology department in Dr. Ulazpatil Medical College Hospital. I am present before you a paper on the role of my imaging and evaluation of anorectal fistula. Fistula and anode is a track line, my granulation tissue which connects perianal skin superficially to anal canal anorectum, not rectum deeply. It usually occurs in pre-existing anorectal abscess, which was spontaneously. Its wall is made up of inflammatory granulation as well as fibrous tissue. Perianal fistula occurs in approximately 10 out of 10,000 people. It usually occurs in adult men with maximum incidence between 3rd and 5th decades. The most common presenting symptoms are pain and discharge. Perianal fistula sometimes lead to acute abscess formation where immediate decompression becomes necessary. However, most simple fistula can be treated electively using fistula torment. The goal of the treatment in an anal fistula is to eliminate the primary opening, any associated tracks and any secondary opening without loss of contact. The external opening is visible on inspection and internal opening can be determined by probing. However, its seldom helps and is not recommended these days. The role of imaging is to define the course of track between these openings so that the appropriate surgical option can be used. Surgical treatment of fibrous tissue is notorious for high recurrence rates. The successful surgical management of fibrous tissue depends upon accurate preoperative assessment of the course of the primary fibrous tissue track, the presence and the site of any secondary extension or abscess. Thus, the role of MR is to evaluate the fibrous tissue, define its anatomy and help in planning the management and surgeon. The aim is basically to determine the role of MR in diagnosing and discriminating characteristics of fistula in an anal preoperative assessment of perianal fistula. So, our study includes 30 patients with suspected perianal fistula having one or more external openings visiting OPD or admitted to an institute. Both men and women were included in our study. Previously operated patients with recurrent perianal disease were excluded from the study. All patients underwent MR imaging examinations on Siemens 1.5 Tesla MR machine using body surface coil. Sequences were acquired in both coronal and axial planes. MR protocol consists of axial T1, axial T2, axial T2, fat sat axial, post contrast fat sat axial, coronal and associated sequences. St. James University Hospital MR imaging classification of perianal fistula was used to classify fistula. Both internal and external openings were recorded as the positions on anal clock and at the correct level in anal canal rectum. Distance from a fistula will act as an anal contrast. Celine will only be injected in the cutaneous opening if it is required. So, basically this is a normal MR anatomy of male and you can see there is an anal fossa, there is anal canal, there is internal sphincter, there is external sphincter here. And when we talk about fistula, the good souls rule is a must. So, it states that an external opening anterior to the transverse anal line will drag into a straight sinus in a radial manner while an external opening posterior to the transverse anal line will follow a curve course to the posterior midline. An exception to this rule is the external openings three centimetres away from the anal verge. So, we have the Parkes classification here and we have two classification and we have the Parkes and the St. James University and the Parkes are basically four types. In this inter sphincter, there is trans sphincter, there is supra sphincter and there is external sphincter. And we while reporting use the St. James University MR classification. So, we grade it accordingly. So, grade zero is basically normal appearance, grade one is simple linear inter sphincter fistula. There is grade two inter sphincter fistula with secondary fistula and abscess. Third is trans sphincter fistula. Both is trans fistula with an abscess or secondary drag with an SUNL or SU rectal fossa. Fifth is supra-nevator and trans-nevator disease. Grade one. So, we as we can see in this image on T2 store transverse and two store coronal images, it shows a simple linear non-branching inter sphincter fistula strand in the left perianal region without crossing the midline. Or involving structure spaces. In grade two, we can see there's this high signal intensity fluid collection along the right postural lateral aspect of an alkanal. And as you can see in this contrast and as T1 path suppress T1 weighted image, you can see the abscess in the right postural lateral aspect of inter sphincter space bounded by external sphincter. This is grade two. In grade three, we have a highly enhancing trans sphincter fistula piercing through the external sphincter noted above the anal words and coarsing postural infinitely into the SU rectal fossa. And grade four is basically it shows a trans sphincter fistula with its opening at two o'clock. Okay. With its internal opening at two o'clock and go on T1 weighted image. It shows the same trans sphincter fistula and on axial contrast image and as fat suppress T1 weighted image it shows an abscess in the left is your rectal fossa in the same patient. In grade five shows a hyper intense trans sphincter fistula at five o'clock position with partial cost of application such they were super sphincter fistula. And so results with 30 patients were eligible for the study. There were six females and 24 males. The ages range between 25 to 65 with a mean of 45 years. The most common present complaint was pain in 12 patients followed by discharging five patients 16 patients had single fistula and four at multiple barrier and fistula. 10 cases had grade one fistula, four had grade two fistula, two cases had grade three fistula and three cases had grade four fistula and the rest one case had a grade five fistula. These are the statements to discussion. Basically the clinical examination got often difficult because of induration and inflammation in the patient with anal sepsis. Previous fistula surgery, the complexity of the fistula strike lack of identification of internal fistula. So opening only diagnosed primary tracks and missed secondary tracks have been identified as independent as factors associated with a poor outcome after surgery. At a more major identification and localization of the entire crypto granular fistula, including the external opening, the primary track, the secondary track, the abscesses and the internal opening are essential for fistula classification and treatment. Inadequate assessment of the fistula may result or may result in a simple fistula developing into a complex fistula and failure to recognize secondary extensions can designate decadent sepsis and unnecessary protracted clinical goals. So imaging has emerged as the imaging technique of choice. It's a gold standard basically for preoperative evaluation of perianal fistula, providing the highly accurate rapid and non-invasive means of performing pre-surgical assessment. MI imaging improves and provides precise definition of the fistula strike along with its relationship to pelvic structures and allows identification of secondary tracks or abscess. Accordingly, MI imaging provides accurate information for appropriate surgical treatment, decreasing the incidence of recurrence and allowing side effects such as fetal incontinence to be avoided. Religious should be familiar with the anatomic and pathological classification of perianal fistula and classify them using the St. James University Hospital MI imaging grades. In this way, appropriate surgical management can be planned and recurrences can be provided. These are my references. Thank you.