What are the role of imaging studies in the treatment of pilonidal disease?
Any time you perform an imaging study of one kind or another, it is important that the result adds to your understand what is going on, and helps guide treatment. There are various studies used to evaluate the presence and extent of pilonidal disease, including ultrasound, CT scan, and MRI.
- Ultrasound bounces sound waves off the tissues, and by looking at what bounces back, can make a determination regarding whether there is a pocket of fluid or air under the surface.
- A CT Scan uses X-ray beams in a circular manner, to reconstruct a 3D image of the tissues, and can show fluid, sinus tracts, swelling or inflammation.
- A MRI can show anatomic changes, as does the CT Scan, and can also pick up inflammation.
In general, a careful history and physical examination can give a surgeon all the information they need in order to determine if a patient has pilonidal disease; imaging studies are rarely necessary. It helps if the surgeon has extensive experience with pilonidal disease and a high index of suspicion regarding its presence when there is pain or drainage in the gluteal cleft.
In our clinic, we use these imaging studies only in the unusual situation where it is unclear why a patient is having pain – particularly if it is after surgery, and there are no physical findings to explain the discomfort.
I don’t use imaging studies to determine if a patient has pilonidal disease or to define the extent, nor do I find it necessary to plan my operative approach.
So, in general, the answer is “no”, the odds are you don’t need an MRI to figure out what is going on.