自制可调节肛肠水囊在普通MRI肛瘘术前分型中的应用

目的:初步评价自制可调节肛肠水囊在肛瘘患者术前普通MRI分型中的应用价值。方法:使用Philips 1.5 TAchievaDual MR扫描仪和体线圈对18例经手术证实的肛瘘患者在放置自制可调节肛肠水囊前、后均各行一次MRI检查。序列包括TSE的T_1WI及T_2WI SPAIR横断位和冠状位。放置水囊前后比较瘘管末端位置,并且对瘘管、分支及脓腔进行计数。结果用于评估肛瘘临床术前分型,同时与手术结果相对照。结果:18例肛瘘患者MRI检查共发现瘘管31根、分支19根、内口22个以及脓腔10个。使用水囊前后,MRI对瘘管末端位置的显示有显著不同(x~2=5.56,P0.05)。使用水囊前,MR显示1例为低位单纯型、2例为低位复杂型、2例为高位单纯型、8例为高位复杂型肛瘘,5例无法确定;使用水囊后,相应数据分别为1、2、3、11例,1例无法确定。使用水囊前后,MRI对肛瘘的分型与手术的相符率分别为72%(13例)和94%(17例),差异无统计学意义(P=0.08)。结论:通过使用自制可调节肛肠水囊,普通MRI能够提供更多有关瘘管及其走行的信息,有助于肛瘘患者的术前分型。

Application of self-adaptive ano-rectal water plug for pre-operative classification of perianal fistulas in conventional MR imaging

Objective： To evaluate the clinical pre-operative value of using an innovative self-adpative ano-rectal water plug for the classification of perianal fistulas patients in conventional MRI examinations. Methods： Eighteen perianal fistulas patients underwent Philips 1.5T Achieva Dual MR scans with a body coil before and after using an innovative self-adaptive ano-rectal water plug with axial and coronal TSE T1WI and Tz WI SPAIR sequences. Whether the end locations of fistulas could be distin- guished above or below the ano-rectal ring were compared with and without the water plug. The number of fistulas, exten- sions, the internal openings and abscesses were counted. All MR findings were utilized to evaluate for the preoperative classifi- cation of the fistulas and compared with the surgery results. Results： There were 31 fistulas, 19 extensions, 22 internal openings and 10 abscesses observed on MRI studies. There were significant differences in the end locations of fistulas on MR images before and after using water plug （χ2=5.56, P〈0.05）. According to MR images, 1 low simple, 2 low complex, 2 high simple and 8 high complex fistulas were classified without water plug, and 5 fistulas were uncertain. With water plug, the corresponding figures were 1, 2, 3 and 11, and 1 were uncertain. Before and after using the water plug, complete agreement between MRI and surgery for the pre-operative classification occurred in 13 （ 72% ） and 17{94%}, and there was no significant differences （ P =0.08）. Conclusion： By using an innovative self-adaptive ano-rectal water plug, conventional MRI can provide more information of the fistulas and their routes, and it is useful in the pre-operative classification of the perianal fistulas patients.