Background: The main aim of the current study is to evaluate the added value of DW-MRI in diagnosis ‎of perianal fistula taking the surgical treatment as the golden standard for our findings. ‎

Methods: The present study is a retrospective analysis that involved a cohort of 36 individuals ‎who were clinically diagnosed with perianal fistula. These patients underwent magnetic ‎resonance imaging (MRI) using a 1.5-T scanner. Three distinct b-values were utilized to ‎conduct DWI sequences. Additional regular MRI sequences were incorporated. MRI images ‎were analyzed in order to assess and evaluate the diagnostic effectiveness of the diffusion-‎weighted MRI sequence with other sequences in the diagnosis of perianal fistula. Post-‎surgical data has always been considered the main reference for assessing diagnostic efficacy.‎

Results: Among 36 cases confirmed with perianal fistula by surgical intervention, 28 cases ‎‎(true positive) were detected by MRI, and 8 cases were missed (False negative) while all the 36 ‎cases were detected by DWI, so MRI had (77.8%) sensitivity while DWI had (100%) ‎sensitivity, with adding value 22.2% over MRI for diagnosis of fistula. In our study, we ‎reported the presence of abscesses in 11.1% of examined cases.‎

Conclusion: MRI is the modality of choice for preoperative evaluation of perianal fistula; ‎however DWI had an added value over other MRI sequences in detection and diagnosis of such ‎cases. This highlights the role of DWI-MRI in drawing a map, especially for surgeons ‎aiming ‎for successful surgical interventions.