Perianal lesions encompass a broad spectrum of infectious, inflammatory, and neoplastic conditions, which often present with overlapping clinical features. Accurate imaging evaluation is crucial for diagnosis, treatment planning, and surgical guidance. This review analyzes CT and MRI findings of common perianal pathologies, including abscesses, fistulas, epidermoid cysts, hemangiomas, and malignancies such as squamous cell carcinoma and melanoma. MRI is particularly valuable due to its superior soft tissue contrast and multiplanar capability, allowing precise assessment of lesion extent, fistula tracts, and involvement of sphincter muscles. CT remains useful for detecting associated pelvic infections or complications. Recognizing characteristic imaging patterns improves diagnostic confidence and reduces unnecessary interventions.

Keywords: Perianal Lesions, CT Imaging, MRI Imaging, Differential Diagnosis