Aim: The management of fistula in-ano has been based on digital examination and operative findings. This study was conducted to asses the diagnostic accuracy of magnetic resonance imaging (MRI) with endorectal coil in perianal fistula. 
Patients And Methods: Twenty patients with anal fistula were classified into two groups. The first one included those who had primary fistula (10 patients) and the second included those with recurrent fistula (10 patients). All patients underwent preoperative MR imaging using endorectal coil. The findings were compared to examination under anesthesia (EUA) and final surgical findings. 
Results: Comparing MRI with operative data (EUA and final surgical results); in the first group with simple fistula, MR imaging showed additional information than examination under anesthesia in only one patient (10%) and did not diagnose one fistulous tract at all. In the second group, MRI detected 8 internal openings correctly and one opening was missed. MRI added information than EUA in 6 patients, its falacies was noted in 2 patients. 
Conclusion: MRI with endorectal coil could be very useful and reliable in defining fistula anatomy, assesing relationship with anal sphincter, identifying secondary extensions (particularly horseshoe tracts) and planning surgical strategy.