3.0T高分辨率磁共振成像在肛瘘诊断及分型中的应用

目的探讨3.0T高分辨MRI在肛瘘术前诊断及分型的应用价值。方法选取经手术证实的51例肛瘘患者的临床资料及MRI表现,并与手术结果对照分析,总结肛瘘的MRI表现特点及应用价值。结果51例肛瘘手术显示内口56个,外口43个,主瘘管51条、瘘管分支14条,脓肿16个。与手术结果对照,术前MRI显示肛瘘内、外口、主瘘管及支管的准确率分别为94.64%(53/56个)、100%(43/43个)、94.12%(48/51条)及85.71%(12/14条),对脓肿显示的准确率为100%(16/16个)。按照Parks分型,51例患者MRI共检出括约肌间型肛瘘23例(45.10%),经括约肌型肛瘘17例(33.33%),括约肌上型肛瘘7例(13.73%),括约肌外型肛瘘4例(7.84%),MRI分型准确率为96.08%(49/51例)。MRI在肛瘘Parks分型上与手术结果一致性高,差异无统计学意义(P>0.05)。结论MRI能准确显示肛瘘内、外口的位置,瘘管的数量及走行,能够对肛瘘进行准确分型。     

湿热下注型肛瘘的MRI评价

目的：评估术前MRI检查对湿热下注型肛瘘的主瘘管、内口、分支及相关脓肿的诊断准确性。方法：收集311例湿热下注型肛瘘的临床及MRI资料，观察MRI影像上主瘘管的数目及走行、内口的数目及位置、分支的数目及形态，以及相关脓肿等影像学特征，并与手术结果进行严格对照，分析诊断灵敏度，评价分型准确性。结果：(1)311例湿热下注型肛瘘，男性267例，平均年龄（40.00±12.14）岁，女性44例，平均年龄（39.75±10.83）岁，体重指数（BMI）为（25.14±3.83）kg/m2,113例有过脓肿切开引流史。(2)311例湿热下注型肛瘘中，单纯性肛瘘195例（62.70%），复杂性肛瘘116例（37.30%），共有主瘘管371个，内口374个，分支82个（马蹄形分支14个，非马蹄形分支68个），脓肿53个，外口370个；MRI显示主瘘管、内口、分支及相关脓肿的灵敏度分别为94.61%、90.37%、93.90%和100%。(3)参考Parks分型，371个主瘘管中，窦4个，黏膜下瘘/括约肌间型205个，经括约肌型150个，括约肌上型11个，括约肌外型1个，MRI诊断分型与手术结果具有较...     

磁共振成像检查在肛瘘手术中的应用价值

目的讨论磁共振成像(MRI)检查在肛瘘手术中的应用价值。方法收集27例经手术证实为肛瘘的患者,术前均进行MRI检查,其中18例行增强扫描,扫描序列主要包括轴位T1加权成像,轴位、矢状位、冠状位脂肪抑制T2加权成像,轴位弥散成像,增强轴位、矢状位、冠状位脂肪抑制T1加权成像。将MRI检查诊断结果与手术结果进行比较。结果 27例患者中,术前MRI检查发现瘘管30条,支管8条,外口29个,内口25个,并发肛周脓肿2例。MRI对显示主瘘管和支管的准确率分别为96.8%(30/31)和88.9%(8/9),对外口显示的准确率为96.7%(29/30),对内口显示的准确率为92.6%(25/27),对脓肿显示的准确率为100%(2/2)。结论 MRI检查可准确显示肛瘘,特别是复杂性肛瘘的数目、瘘管走行、支管形成及内口的位置和瘘管与周围肌肉(肛管括约肌、肛提肌)关系、有无脓肿形成,为临床手术治疗提供重要的指导信息,具有很高的应用价值。     

MRI动态增强扫描对肛瘘的诊断价值

目的 :评价MRI动态增强扫描联合常规MRI扫描对肛瘘的诊断价值。方法 :51例肛瘘患者行常规MRI扫描及动态增强扫描,比较肛瘘内、外瘘口的显示率及瘘管动态强化曲线。结果:MRI动态增强扫描共显示瘘管70个、内口51个、外口52个、脓肿9个;与手术所见比较,显示肛瘘内口、瘘管数量、肛瘘外口和脓肿准确率分别为96.2%、98.3%100.0%和100.0%,79.3%的瘘管强化峰值为165 s。结论:MRI动态增强扫描能提高肛瘘合并肛周脓肿的检出率,并对瘘管炎症活动性的判定有应用价值。     

肛瘘磁共振成像:探讨直肠球囊双腔导管在肛瘘诊断中的价值

目的 探讨MRI中使用直肠球囊双腔导管(BRDCC)在肛瘘患者诊断中的应用价值.方法 36例经手术证实的肛瘘患者于术前行MRI,其中18例使用BRDCC,另18例未使用.对36例患者瘘管、内口、分支及脓腔进行计数.所获结果被用于评估肛瘘MR诊断分型,并同时与手术结果相对照.采用Microsoft Office Excel处理软件分析数据,根据MRI图像对36例瘘管末端位置、内口、分支及脓腔分别进行计数和分型,与手术结果对照计算准确率及运用Chi-square检验观察有无统计学意义.结果 18例使用BRDCC的肛瘘患者MRI上共发现瘘管20支、内口21个、分支10支以及脓腔9个.Park,s分型中8例为括约肌间型,9例为经括约肌型,1例为括约肌外型.与手术结果比较,分型与手术结果一致,瘘管(20/21)、内口(21/22)、分支(10/10)和脓腔(9/9)的准确性分别为95.24％、95.45％、100％和100％;没有1例高低位误诊.18例未使用球囊导管的患者,MRI共发现瘘管26支、内口21个、分支15支以及脓腔6个,Park,s分型中6例为括约肌间型,10例为经括约肌型,1例为括约肌外型,1例为括约肌上型.与手术结果比较,瘘管(26/28)、内口(21/27)、分支(15/16)和脓腔(6/6)的准确性分别为92.86％、77.78％、93.75％和100％,有4例高低位误诊.使用BRDCC对肛瘘患者高低位的显示要显著优于未使用BRDCC者(x2=15.9,P=0.033).结论 通过使用BRDCC,MRI能够获得更多有关瘘管及其走行的信息.     

复杂性肛瘘的高分辨力MRI表现及手术对照分析

目的 :探讨复杂性肛瘘的MRI表现,以提高对复杂性肛瘘的诊断价值。方法 :对20例临床初诊为复杂性肛瘘患者行矢状位T2WI、横轴位T1WI、T2WI抑脂、冠状位T2WI抑脂、DWI序列,3例行增强扫描,分析MRI表现,明确各型瘘管的走行、分支及内外口,并与手术结果对照。结果:MRI检查发现内口25个,诊断准确率89.3%(25/28),18例内口T2WI抑脂表现高信号、T1WI与肌肉信号相似,15个DWI呈高信号;瘘管及分支27支,瘘管分支T2WI抑脂序列表现高信号21支,6例瘘管壁纤维组织T1WI、T2WI均呈低信号;脓肿、肛周间隙蜂窝组织炎5例,与手术结果一致,呈条索状、团块状,T1WI均呈低信号,T2WI及DWI均呈高信号;3例增强扫描内口呈环形强化。结论:MRI可准确显示复杂性肛瘘的类型、瘘管走行、分支、内口位置、瘘管与周围肌肉关系以及有无脓肿形成等。     

DWI联合常规MR扫描对肛瘘的诊断价值

目的:评价DWI联合常规MR扫描对肛瘘的诊断价值.方法:选取20例临床怀疑肛瘘或有肛瘘手术史患者行常规MR扫描及DWI检查,比较肛瘘内、外瘘口,瘘管分支及脓肿的显示率.结果:常规MR扫描序列共显示瘘管22个、内口14个、外口22个、脓肿14个;DWI检查共显示瘘管25个、内口16个、外口23个、脓肿17个.结论:DWI...     

MRI对肛瘘的诊断价值

目的:探讨高分辨力MRI对肛周窦道及瘘管的诊断价值。方法:收集158例肛瘘患者,术前均行MRI检查,检查序列主要包括矢状面、冠状面快速自旋回波T_2WI、T_1WI及脂肪抑制PDWI,并比较影像学诊断与手术结果。结果 :158例肛瘘共183个原发瘘管,184个内口,171个外口,124个肛周脓肿。MRI对肛瘘原发瘘管,肛周脓肿及内口显示的灵敏度分别为95.6%,99.1%,93.1%。结论 :MRI可准确判断肛瘘的分型、瘘管走行、有无脓肿、支管形成,以及肛瘘内口的位置,为临床治疗提供重要信息。     

3.0 T磁共振3D CUBE T2 WI抑脂序列对肛瘘的诊断价值

目的 探讨3.0T常规MRI T2 WI抑脂序列联合三维超长回波链采集FSE(3D CUBE) T2 WI抑脂序列对肛瘘患者的临床诊断价值.方法 回顾性分析33例经手术证实的肛瘘患者术前常规MRI T2WI抑脂序列及3DCUBE T2 WI抑脂序列资料.比较两种技术评价肛瘘分型、瘘管支数、内口总数、外口数目、肛周脓肿和瘘管整体的优势,并与手术结果相对照.结果 手术发现33例肛瘘中,经括约肌瘘14例,括约肌间瘘10例,括约肌外瘘8例,括约肌上瘘1例.瘘管支数52个,内口45个,外口48个,肛周脓肿30个.常规MRI T2WI抑脂序列与常规MRI T2WI抑脂序列联合3D CBUE T2WI抑脂序列肛瘘的分型准确率分别为78.8％ (26/33)和87.9％ (29/33),差别无统计学意义(JP＞0.05);瘘管支数显示率分别为71.2％(37/52)和90.4％ (47/52),内口总数显示率分别为71.1％ (32/45)和91.1％ (41/45),差异具有统计学意义(P＜0.05).两种技术显示外口数目和肛周脓肿与手术结果一致.结论 常规MRI T2WI抑脂序列联合3D CUBE T2WI抑脂序列能准确显示瘘管支数、内口总数和瘘管整体,优于常规MRI T2 WI抑脂序列,为临床术前提供更详尽的影像解剖信息.     

复杂性肛瘘的高分辨MRI表现及手术对照分析

目的：探讨复杂性肛瘘的MRI表现,以提高对复杂性肛瘘的诊断价值。方法：对20例临床初诊为复杂性肛瘘患者行矢状位T₂WI、横轴位T₁WI、T₂WI抑脂、冠状位T₂WI抑脂、DWI序列,3例行增强扫描,分析MRI表现,明确各型瘘管的走行、分支及内外口,并与手术结果对照。结果：MRI检查发现内口25个,诊断准确率89.3%（25/28）,18例内口T₂WI抑脂表现高信号、T₁WI与肌肉信号相似,15个DWI呈高信号;瘘管及分支27支,瘘管分支T₂WI抑脂序列表现高信号21支,6例瘘管壁纤维组织T₁WI、T₂WI均呈低信号;脓肿、肛周间隙蜂窝组织炎5例,与手术结果一致,呈条索状、团块状,T₁WI均呈低信号,T₂WI及DWI均呈高信号;3例增强扫描内口呈环形强化。结论：MRI可准确显示复杂性肛瘘的类型、瘘管走行、分支、内口位置、瘘管与周围肌肉关系以及有无脓肿形成等。     

磁共振成像对肛瘘分级的价值

目的探讨磁共振成像（MRI）对肛瘘分级价值。方法经手术证实的肛瘘患者26例,全部行MRI检查,检查序列主要包括轴面T1WI、T2WI和轴面、冠状面抑脂T2WI序列。结果 26例肛瘘中,Ⅰ级10例,Ⅱ级6例,Ⅲ级5例,Ⅳ级3例,Ⅴ级2例。MRI诊断26例肛瘘中共有28个瘘管,26个内口,31个外口,14个脓肿,敏感度分别达93%、93%、97%、100%。结论 MRI可以对肛瘘准确分级,对正确的手术治疗非常重要。     

Reliability of endosonography in evaluation of anal fistulae and abscesses

Objective:
To assess the reliability of anal endosonography (AES) in the diagnosis of anal fistulae and abscesses. Material and Methods:
86 patients with different types of anal fistulae and abscesses were prospectively examined with a 7.0 MHz transducer. Type of anal fistulae, differentiation between simple and complex tracts, and location of their internal openings were defined. In 66 cases with permeable external opening, hydrogen peroxide solution was introduced into the fistula tract. Reliability of AES was defined after surgical treatment of all cases. Results:
74 anal fistulae, including 43 transsphincteric, 11 intersphincteric, 6 suprasphincteric, 3 superficial, and 11 ano-vaginal were found on AES. 27 fistulae were complex, and 47 simple fistulae. In 10 patients a coexisting abscess was found; the remaining 12 abscesses were without any fistula. Surgery confirmed the type of anal fistula in 64 patients (86.5%), and location of internal openings in 60 cases (81.1%). All abscesses were confirmed. Conclusion:
AES showed high accuracy in diagnosing anal fistulae and abscesses.     

超声、CT及MRI在评价体表窦瘘中的对照研究

目的:探讨CT、MRI及超声检查在体表窦瘘中的应用价值。方法:回顾性分析53例体表窦瘘患者的临床和影像资料,患者术前均行CT、MRI及超声检查,对照手术所见,评价3种影像学方法对体表窦瘘的诊断准确率及对复杂性窦瘘支管、脓肿及内口显示的敏感度。结果:53例中,单纯窦道22例,复杂性窦瘘31例。单纯窦道患者CT、MRI及超声检查的准确率分别为100%、100%、95.45%,其差异无统计学意义(P0.05);复杂性窦瘘患者CT、MRI及超声检查的准确率分别为93.55%、96.77%、70.97%,其差异有统计学意义(P0.05),CT与MRI的准确率优于超声,而CT与MRI的诊断准确率差异无统计学意义(P0.05)。CT、MRI及超声检查对复杂性窦瘘支管的敏感度分别为95.24%、98.41%、55.56%,脓肿的敏感度分别为90.00%、100%、70.00%,内口的敏感度分别为80.00%、80.00%、40.00%。对于支管显示的敏感度,CT与MRI高于超声(P0.05),CT与MRI间差异无统计学意义(P0.05)。对于脓肿及内口显示的敏感度,三者间差异无统计学意义(P0.05)。结论:对于单纯窦道,超声检查方便经济;复杂性窦瘘,CT、MRI检查存在很大优势。     

肛瘘磁共振成像:探讨自制可调节肛肠水囊在肛瘘分级中的价值

目的:探讨普通MR成像中使用自制可调节肛肠水囊在肛瘘患者分级中的应用价值.方法:18例经手术证实的肛瘘患者于使用自制可调节肛肠水囊前、后均各行一次MRI检查.序列包括T_1 WI横断位和冠状位、T_2 W SPAIR横断位,冠状位及矢状位.放置水囊前后比较瘘管末端位置,并且对瘘管、内口、分支及脓腔进行计数,同时观察瘘管走行.所获结果被用于评估肛瘘MR诊断分级,并同时与手术结果相对照.结果:18名肛瘘患者MRI检查共发现瘘管31根、内口22个、分支19根以及脓腔10个.使用水囊前后MRI对瘘管末端位置的显示有显著不同(χ~2=5.56,P<0.05).使用水囊前,MR显示1例1级低位单纯线形括约肌内肛瘘,1例低位和2例高位2级括约肌内肛瘘伴脓肿或分支,1例3级高位经括约肌肛瘘,6例4级经括约肌肛瘘伴脓肿或分支,其中5例为高位,1例为低位,2例5级高位肛提肌上和经肛提肌肛瘘,另有5例无法确定;使用水囊后,2级高位括约肌内肛瘘伴脓肿或分支上升为3例,4级低位经括约肌肛瘘伴脓肿或分支上升至2例,高位上升至7例,另有1例无法确定,余小变.使用水囊前后,M RI对肛瘘分级与手术的相符率分别为72%(13例)和94%(17例).结论:通过使用自制町凋节肛肠水囊,普通M RI能够获得更多有关瘘管及其走行的信息,有助于肛瘘患者的分级.     

3.0 T MRI在复杂型肛瘘术前诊断中的应用

目的:探讨3.0T MRI在复杂型肛瘘术前诊断中的应用价值。方法:收集21例经手术治疗的复杂型肛瘘患者的临床及影像资料,患者均行MRI平扫及增强扫描,对比手术结果,评价复杂型肛瘘的MRI分级及MRI诊断主管、支管、内口、脓肿的准确性。结果:复杂型瘘管T1WI可见10条或多条状等或稍低信号,T2WI、T2WI抑脂及SPAIR为高信号,增强扫描示瘘管壁明显强化、脓液不强化。MRI诊断与手术所见对照,显示肛瘘内口、外口、主管、支管和脓肿符合率分别为88.00%、100%、97.37%、70.00%和100%。结论:MRI在复杂型肛瘘术前诊断中具有较大的实用价值。     

Preoperative MR imaging of anal fistulas: Does it really help the surgeon?

PURPOSE: To evaluate the accuracy of magnetic resonance (MR) imaging with a quadrature phased-array coil for the detection of anal fistulas and to evaluate the additional clinical value of preoperative MR imaging, as compared with surgery alone. MATERIALS AND METHODS: Fifty-six patients with anal fistulas underwent high-spatial-resolution MR imaging. Twenty-four had a primary fistula; 17, a recurrent fistula; and 15, a fistula associated with Crohn disease. MR imaging findings were withheld from the surgeon until surgery ended and verified, and surgery continued when required. RESULTS: MR imaging provided important additional information in 12 (21%) of 56 patients. In patients with Crohn disease, the benefit was 40% (six of 15); in patients with recurrent fistulas, 24% (four of 17); and in patients with primary fistulas, 8% (two of 24). The difference between patients with or without Crohn disease and between patients with a simple fistula versus the rest was significant (P <.05). The sensitivity and specificity for detecting fistula tracks were 100% and 86%, respectively; abscesses, 96% and 97%, respectively; horseshoe fistulas, 100% and 100%, respectively; and internal openings, 96% and 90%, respectively. CONCLUSION: High-spatial-resolution MR imaging is accurate for detecting anal fistulas. It provides important additional information in patients with Crohn disease-related and recurrent anal fistulas and is recommended in their preoperative work-up.     

质子加权预饱和脂肪抑制序列在肛瘘中的应用价值

目的评价质子加权预饱和脂肪抑制序列(PDW PFS)对肛瘘显示的准确性及图像质量的清晰性,探讨PDW PFS在肛瘘中的应用价值。资料与方法 20例经手术证实的肛瘘患者术前进行MRI检查,序列包括T1WI、T2W频谱选择性衰减反转恢复序列(SPAIR)和PDW PFS。MRI检查前均向患者肛管直肠内置入肛肠水囊以撑开肛管和直肠。获得图像后,观察患者的瘘管、内口和肛周脓肿,评估和比较MRI各序列显示的瘘管、内口、脓腔,并对PDW PFS和T2W SPAIR序列瘘管的信号强度(SI)、信噪比(SNR)及瘘管与周围肌肉的对比噪声比(CNR)进行测量及比较。结果 PDW PFS序列显示瘘管(100%)、内口(95.7%)、肛周脓肿(100%)的准确率较T1WI及T2WSPAIR序列为高。Kruskal Wallis检验显示上述各序列对瘘管(χ2=6.95,P<0.05)及内口(χ2=31.53,P<0.05)的显示具有显著统计学差异,PDW PFS序列显示瘘管及内口最多。PDW PFS序列SI、SNR值和CNR值均显著高于T2W SPAIR序列(P<0.05)。结论 PDW PFS成像技术具有较高的图像SNR和CNR,更易认识辨别瘘管和内口,可以作为一种新的无创性磁共振成像技术应用于肛瘘成像。     

Usefulness of hydrogen peroxide enhancement in diagnosis of anal and ano-vaginal fistulas

Our objective was to assess if contrast-enhanced (CE) anal endosonography (AES) with hydrogen peroxide is useful in the diagnosis of anal and ano-vaginal fistulas. A Bruel and Kjaer scanner with a 7.0-MHz transducer was used. After visualization of the fistula tract in non-contrast (NC) AES, hydrogen peroxide was introduced into the fistula tract through the external opening in 22 patients with different types of anal fistulas. Both CE and NC AES revealed 13 transsphincteric, 3 intersphincteric, 2 suprasphincteric and 4 ano-vaginal fistulas. Simple tracts were found in 16 cases and complex in 6 cases in non-contrast AES. The CE AES revealed 19 simple and 3 complex fistulas. Fifteen internal openings visible in NC AES were confirmed in CE AES in 6 cases, which additionally found 11 more internal openings. Surgery confirmed all types of fistulas found in NC and CE AES; however, the latter two found 18 simple and 4 complex fistulas, and 21 internal openings. Both NC and CE AES are able to correctly differentiate types of anal fistulas and are of comparable value in differentiating simple from complex fistulas, although a false-negative result was found in CE AES. In the preoperative assessment of the internal opening, CE AES is superior to NC AES. Electronic Publication