Descreva o achado como no laudo. A resposta aponta uma das categorias publicadas, com a probabilidade e o trecho que a decide.
Categorias
Reescritas a partir da fonte e citadas
1
1 de 5
Grade 1
Simple linear intersphincteric fistula (single tract penetrating the internal sphincter to run between internal and external sphincters and exit the perineum, with no secondary extension or abscess).
CondutaCounts as a 'simple'/low fistula: generally amenable to laying-open (fistulotomy/fistulectomy) with low risk of incontinence, since no external-sphincter muscle is divided.
RiscoFavorable: grades 1-2 were associated with a satisfactory outcome, versus grades 3-5 (unsatisfactory, e.g. need for further surgery; P<0.001) in the cited series.
verificadoMR imaging classification of perianal fistulas (St James University Hospital)Criteria/management/outcome: PMC4394844 ('MRI of Perianal Fistulas'), section 'Classification of Perianal Fistulae' (Grade 1 = 'a simple intersphincteric fistula' penetrating between the sphincters) and the outcome statement 'grades 1 and 2 were associated with satisfactory outcome whereas grades 3-5 were associated with unsatisfactory outcome ... (P<0.001)'; simple/low-fistula fistulotomy principle from the same article.
2
2 de 5
Grade 2
Intersphincteric fistula with an intersphincteric secondary tract or abscess.
CondutaStill intersphincteric (no trans-sphincteric muscle involvement) but with a secondary tract/abscess that must be drained/laid open in addition to treating the primary tract; broadly grouped with the lower-risk fistulas for sphincter-sparing intent.
RiscoFavorable: grades 1-2 were associated with a satisfactory outcome (vs unsatisfactory for grades 3-5; P<0.001) in the cited series.
verificadoMR imaging classification of perianal fistulas (St James University Hospital)Criteria: PMC4394844, 'Classification of Perianal Fistulae', Grade 2 = 'an intersphincteric fistula with a secondary tract or abscess'. Outcome/risk: same article, 'grades 1 and 2 were associated with satisfactory outcome whereas grades 3-5 ... unsatisfactory ... (P<0.001)'.
3
3 de 5
Grade 3
Simple (uncomplicated) transsphincteric fistula (tract crosses both the internal and external sphincters into the ischioanal fossa without secondary extension or abscess).
CondutaTrans-sphincteric tracts cross the external sphincter, so simple laying-open risks incontinence (>50% with the lay-open technique for complex disease); sphincter-preserving options (e.g. seton, advancement flap) are favored, the more so with the higher grades.
RiscoLess favorable: grades 3-5 were associated with an unsatisfactory outcome (e.g. need for further surgery), in contrast to satisfactory outcomes for grades 1-2 (P<0.001) in the cited series.
verificadoMR imaging classification of perianal fistulas (St James University Hospital)Criteria: PMC4394844, 'Classification of Perianal Fistulae', Grade 3 = 'simple transphincteric fistulae'. Management/outcome: same article — incontinence '>50%' with laying-open of complex fistulas, and 'grades 3-5 were associated with unsatisfactory outcome ... (P<0.001)'.
4
4 de 5
Grade 4
Transsphincteric fistula with an associated secondary tract or abscess (a more complicated transsphincteric process), typically extending into the ischioanal/ischiorectal fossa.
CondutaComplex fistula: laying-open is avoided (incontinence in >50% of cases); managed with sphincter-preserving and/or staged techniques (non-cutting seton, mucosal advancement flap) plus drainage of the secondary tract/abscess.
RiscoUnfavorable: grade 4 falls in the grades 3-5 band associated with an unsatisfactory outcome / need for further surgery (vs satisfactory for grades 1-2; P<0.001) in the cited series.
verificadoMR imaging classification of perianal fistulas (St James University Hospital)Criteria: PMC4394844, Grade 4 = 'a more complicated transphincteric process with a secondary tract or abscess'; ischioanal/ischiorectal-fossa site corroborated by WebSearch summaries of St James / Morris 2000 on pmc.ncbi.nlm.nih.gov. Management/outcome: same article — complex fistulas need sphincter-preserving/staged surgery (lay-open incontinence '>50%') and 'grades 3-5 ... unsatisfactory outcome ... (P<0.001)'.
5
5 de 5
Grade 5
Supralevator and/or translevator disease (a complicated fistula/abscess with a supralevator or translevator component, extending above the level of the levator ani).
CondutaMost complex group: requires sphincter-preserving and often staged/specialist surgery (seton, advancement flap, treatment of the supra/translevator component) with imaging-guided planning; simple laying-open is contraindicated given the high incontinence risk.
RiscoMost unfavorable: grade 5 lies in the grades 3-5 band associated with an unsatisfactory outcome / need for further surgery (vs satisfactory for grades 1-2; P<0.001) in the cited series.
verificadoMR imaging classification of perianal fistulas (St James University Hospital)Criteria: PMC4394844, Grade 5 = 'a complicated abscess with a supra or translevator component'. Management/outcome: same article — complex/high disease needs sphincter-preserving/staged surgery (lay-open incontinence '>50%') and 'grades 3-5 were associated with unsatisfactory outcome ... (P<0.001)'.
Lógica de decisão estruturada
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"categories": [
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Referência, não é dispositivo médico. Confira a publicação primária vigente. O radiologista que assina o laudo continua autor e responsável.