Structured versus narrative reporting of pelvic MRI in perianal fistulizing disease: impact on clarity, completeness, and surgical planning

Objective: To evaluate clarity, completeness, and impact on surgical planning of MRI reporting of perianal fistulizing disease using a structured disease-specific template versus narrative reporting for planning of disease treatment by colorectal surgeons. Materials and methods: In this HIPAA-compliant, IRB-approved study with waiver of informed consent, a structured reporting template for perianal fistulizing disease MRIs was developed based on collaboration between colorectal surgeons and abdominal radiologists. The study population included 45 consecutive patients who underwent pelvic MRI for perianal fistulizing disease prior to implementation of structured reporting, and 60 consecutive patients who underwent pelvic MRI for perianal fistulizing disease after implementation of structured reporting. Objective evaluation of the reports for the presence of 12 key features was performed, as also subjective evaluation regarding the clarity and completeness of reports, and impact on surgical planning. Results: Significantly more key features were absent in narrative reports [mean: 6.3 ± 1.8 (range 3–11)] than in structured reports [mean: 0.3 ± 0.9 (range 1–5)] (p ≤ 0.001). The use of structured reporting also increased the percentage of completeness (72.5–88.3% for surgeon 1, and 61.2–81.3% for surgeon 2; p = 0.05 and 0.03, respectively), helpfulness in surgical planning (7.1 ± 1.5–7.6 ± 1.5 for surgeon 1, and 5.8 ± 1.4–7.1 ± 1.1 for surgeon 2; p = 0.05 and p < 0.001, respectively), and clarity (7.6 ± 1.3–8.3 ± 1.1 for surgeon 1, and 5.2 ± 1.4–7.1 ± 1.3 for surgeon 2; p = 0.006 and p < 0.001, respectively) of the reports. Conclusion: Structured MRI reports in patients with perianal fistulizing disease miss fewer key features than narrative reports. Moreover, structured reports were described as more complete and clear, and more helpful for treatment planning.