 Good evening. So my topic is MRI assessment of perineal fistula introduction perineal fistula is an abnormal tract communicating an external cutaneous opening in the perineal region to an internal opening most often in the anal canal. Perineal fistula is one of the most common and rectal disorders in surgical practice with high prevalence, which predominantly affects young adult males. Anal glands are situated in the intramuscular plane at the level of dentate line in anal canal. The burden of anorectal sepsis is high and persistent infection may spread in circumferential or in axial direction, resulting in different types of fistulas within the first year of presentation with an abscess. Clinically, the PARC's classification and perianal disease activity index can be considered as the milestone for classifying patients with PEF and as the goal standard for evaluating its complexity and severity. Effective surgical treatment of PEF is mandatory to prevent its recurrence, however, the difficulty in recognizing the internal opening and the course of the fistula tract can make successful surgery sometimes challenging. Variously logical modalities were applied for evaluation of fistula patients. Conventional fistulography was used, but its diagnostically is limited, secondary to its difficulty to recognize the internal opening, especially if blocked by debris. Andosanography with color Doppler has greater diagnostic value than conventional base-scale andosanography for PEF evaluation. Three-dimensional ultrasonography improves PEF detection and characterization, so it plays a crucial role in optimal treatment planning, but proficiency is one of its limitations. Transperineal ultrasound is a very accurate diagnostic method, and for its simplicity and low cost, it is recommended to be the first diagnostic mentality for anal fistula. MRI is a reference standard for assessment of perianal fistula, defining anatomy and guiding surgery. The aim of the study is to evaluate the role of MRI in preoperative assessment of perianal fistulas, the methods. So this study was conducted in our department and we included 40 patients of clinically suspected PEF, extracted data included patients' age, gender, weight, height, calculated BMI and disease-related data, clinical data included pain, restriction of daily and or sexual activity, presence of inflamed skin and discharge of pus. And fistulas, they were classified according to the relationship to anal sphincters as inter-swinged shrink fistula, inter-swinged shrink fistula with abscess or secondary tract, trans-swinged shrink fistula, trans-swinged shrink fistula with abscess or secondary tract, within the eschew rectal fossa, supra-swinged and trans-elevate extension, which correspond to St. James University Hospital rating 125, respectively. So this is an image which shows the various types of fistulas. So this is the PAPS classification. The type A is the inter-swinged shrink fistula. The type B is a trans-swinged shrink fistula, which crosses both the internal and external and then the supra-swinged shrink fistula and the extra-swinged shrink fistula. MRI protocol. MRI was performed using a 1.5 Tesla body MRI system and a pelvic-faced array coil. MRI protocol consists of axial T1, axial T2, axial T2 fat set, axial post-contrast fat set, axial core and cell sequences. Inclusion criteria. All the patients with clinically suspected PEF and extrusion criteria included uncooperative patients. So this is the images. So this is the first image which shows a simple linear inter-swinged shrink fistula. So we can see this is there is an axial T2 weighted image with PAPS suppression, which illustrates a simple inter-swinged shrink fistula that traverses internal anal swinter and then extends to skin without crossing the external anal swinter or involving the eschew rectal or eschew anal space. Fistula tract shows high signal density on T2 weighted imaging consistent with active disease. This is a grade 2 fistula and this is a core T1 weighted image post-contrast, which shows a grade 2 inter-swinged shrink fistula. Small abscess is also noted in the inter-swinged shrink space. This is a grade 3 audit trans-swinged shrink fistula where the fistula tract can be seen extending outside of the both internal and external swinter. And this is the grade 4 trans-swinged shrink fistula with abscess formation in the right eschew anal fossa. The results included that of the 40 patients in the study, 15 had a normal study with no evidence of fistula formation. Rest of 25 cases revealed perianal fistula, which were evaluated for the site of primary tract and its ramifications, the location of the internal opening. Out of the 25 cases, 10 were females and 15 were males. Youngest patient included a study was 24 years of age and oldest was 68. So we evaluated the patient data, their complaints, and we found that the two cases that 18 cases had presented with pain, two cases with painless perianal spelling, five cases had history of discharge, two cases had a perianal fistula associated with Crohn's and one of them actually showed a horseshoe abscess formation. So out in a study, 25 cases, five had multiple perianal fistula and rest 20 patients had a single fistula. 12 cases were grade 1, 6 were grade 2, 3 were grade 3, and 3 cases were grade 4, and one case was grade 5. So these are the various charts showing. So the rule of imaging is therefore to outline all the hidden tracks and define the relationship of the track to the anal sphincter. So inadvertent damage to the anal sphincter can lead to anal incontinence and the importance of knowledge of the relationship between the fistula track and the anal sphincter. There are however other indications of imaging in anal fistula. MRI performed adequately should be regarded as a gold standard for preoperative assessment, replacing surgical examination under anesthetic in this regard. And although there are some conflicting results, hydrogen peroxide enhanced endoanalytrocinography may be comparable with MRI. MRI not only helps accurately demonstrate disease extension, but also predict prognosis, make therapy decisions and monitor therapy. So this is the use of the MRI. Thank you.