Background: Magnetic resonance imaging (MRI) is the imaging method of choice for assessing perianal fistulae because of its ability to highlight the connection between perianal fistulae and anal sphincters, fistula extensions, secondary ramifications, and related disorders. Objectives:  This study aimed to evaluate the role of MRI compared to DWI in perianal fistula, to provide a roadmap to surgeons to prevent recurrences or sphincter incontinence, and to evaluate recurrent perianal fistula after surgery. Patients and methods:  This prospective cohort study was conducted in Qena University Hospital, South Valley University, Qena, Egypt in the duration from January 2021 to January 2022.The study included30 patients with perianal fistula. Results:  In the present study more than half of the studied patients had grade 1 when it was classified by St. James's University Hospital classification by MRI (56.7%) or by Combined T2W and DWI (60.05). highly significant agreement between St. James's University Hospital classification by MRI and Grading by Combined T2W and DWI with agreement equal to 89.0%.When compared to T2-weighted imaging on its own, our findings indicated that DWI provided a considerable benefit to the diagnostic process when attempting to identify a perianal fistula. This seem to imply that DWI should be routinely incorporated as an additional step to the more standard strategy for the investigation of perianal fistula using MRI.  Conclusion: According to our findings, DWI significantly improved upon T2-weighted imaging alone in the identification of perianal fistula. As a result, it is suggested that DWI be routinely incorporated to the MRI examination of perianal fistula protocol.