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。     

MRI在肛瘘疾病术前诊断的应用

目的 探讨MRI在肛瘘疾病术前诊断的临床应用价值.方法 回顾性分析经手术证实为肛瘘的患者65例,将术前MRI诊断结果与术后病理结果对比.结果 经手术证实,65例肛瘘患者,低位肛瘘43例,高位肛瘘22例,内口77个、瘘管56条、外口51个、肛周脓肿32个.MRI检查内口灵敏度92.21％,瘘管灵敏度91.07％,外口灵敏...     

MRI多序列成像在肛瘘术前诊断中的应用

目的 探讨体外相位控阵线圈MRI多序列成像在肛瘘术前诊断中的应用价值.方法 回顾性分析经手术证实的42例肛瘘患者临床及MRI影像资料,分析瘘管与内外括约肌的关系及肛瘘的分型,并与手术结果进行对比,评价MRI对肛瘘的分型及瘘管、内口、支管及外口的诊断准确性.结果 42例患者,MRI诊断括约肌间型20例,经括约肌型14例,...     

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。     

肛瘘MRI结构式报告对肛瘘的术前诊断价值

【摘要】目的：探讨肛瘘MRI结构式报告对肛瘘的术前诊断价值。方法：选取156例经手术证实的肛瘘患者,术前行肛瘘多模态MRI检查,根据术前MRI贡献分为对临床有显著价值组（91例）与无显著价值组（65例）,将肛瘘不同分型、瘘管数量、外口、是否累及肛提肌等因素采用Pearson卡方检验或Fisher精确检验进行组间比较,当结果差异有统计学意义时,采用Bonferroni校正后进一步行多重比较。结果：87.8%的患者术前肛瘘MRI结构式报告内容与手术结果相符,临床医生结合肛瘘MRI结构式报告后使37.8%的患者改变手术方式。MRI结构式报告对于复杂性肛瘘、Parks 4型或合并多种类型、累及肛提肌患者的术前诊断价值更高。其中肛瘘不同分型、瘘管数量及肛提肌是否受累在临床有显著价值组与无显著价值组间差异有统计学意义（P<0.005）。结论：肛瘘MRI结构式报告可以完善评估瘘管的解剖结构及相关并发症,在复发、复杂、高级别肛瘘术前评估中价值更高,可为肛瘘手术提供重要的参考信息。     

高位复杂性肛瘘术前MRI检查对手术预后的影响

目前,高位复杂性肛瘘的最有效治疗方式仍然是手术治疗[1],但因其复杂的瘘管走行、高复发率,以及严重后遗症,如瘢痕狭窄、肛门失禁、黏膜外翻等,给外科医生提出挑战。降低复发率和并发症是研究治疗高位复杂性肛瘘的重点。术前有效的评价瘘管的走行和开口,对于指导手术有重要意义。本     

肛瘘的高分辨MRI表现

目的探讨体外相位阵列线圈高分辨MRI对肛瘘检查的准确性及其价值。方法经手术证实的肛瘘患者20例，全部行体外相位阵列线圈高分辨MRI检查，检查序列主要包括高分辨轴面、矢状面和冠状面T2 WI和轴面抑脂T2 WI序列。结果20例肛瘘共27个原发瘘管、24个内口，28个外口，10个肛周脓肿。高分辨MRI对原发瘘管、肛周脓肿、内口显示的敏感度分别为92．6％（25／27）、100．0％（10／10）和91．7％（22／24），特异度分别为92．3％（12／13）、96．3％（26／27）和85．7％（12／14）。结论体外相位阵列线圈高分辨MRI可较准确地判断肛瘘的分型、瘘管走行及有无脓肿形成，对正确的手术治疗非常必要。     

三叉神经痛患者血管压迫MRI表现与手术结果对照研究

目的 分析三叉神经痛患者ＭＲＩ表现,探讨ＭＲＩ对三叉神经痛神经血管压迫的诊断价值。材料与方法 回顾性分析８５例三叉神经痛患者ＭＲＩ表现及手术结果。结果 ８５例三叉神经痛患者共１７０侧脑池段三叉神经ＭＲＩ检查中,５９侧存在三叉神经血管压迫或接触,可疑接触３５侧,其中症状侧有神经血管压迫、接触或可疑接触者为７５例,经统计学分析,三叉神经痛患者症状有无与是否存在血管压迫或接触有显著意义（Ｐ〈０．００１）     

MRI在肛瘘中的临床应用

肛管或直肠因病理原因形成肛门与肛门周围皮肤相通的异常管道,称肛管直肠瘘,简称肛瘘(anal fistula).肛瘘与肛周脓肿分别属于肛周间隙化脓性感染的2个病理阶段[1].肛瘘的特征为肛瘘内口多位于肛窦内,管道穿过肛门直肠周围组织,外口位于肛周皮肤,其脓性分泌物经由外口流出,每因外口闭合导致肿痛,继而破溃流脓,如此反复,经久不愈.现回顾性分析20例肛瘘患者的MRI表现,旨在探讨MRI在肛瘘诊断中的价值.     

直肠内水囊填塞MRI对肛瘘术前诊断的价值研究

目的探讨直肠内水囊填塞MRI对肛瘘术前诊断的价值。资料与方法对52例临床初诊为肛瘘的患者进行MRI检查,将MRI结果与手术结果对照。结果MRI发现瘘管及分支共74支,肛周脓肿16例,内口48例,使用水囊后内口显示率明显提高,并与手术结果一致。在52例肛瘘患者中发现27例为括约肌间型,8例为经括约肌型,8例为括约肌上型,9例为括约肌外型,与手术结果一致。结论直肠内水囊填塞MRI是一种肛瘘术前诊断的有效方法。     

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。     

多次发作肛瘘三种术式疗效比较

 目的 比较三种术式治疗多次发作肛瘘的临床疗效。方法 选取2013-05 至 2014-05本院收治的多次(≥3次)发作的脓肿性肛瘘患者240例,按入院顺序编号,分组为A(编号3N-2)、B(编号3N-1)、C(编号3N)组,1≤N≤80,且为整数;每组各80例;A组患者行肛瘘切除一期缝合术,B组患者行肛瘘切除基底缝合术,C组患者行肛瘘切除半深缝合术,对比各组患者术后各项资料进行统计分析。结果 C组有效率高达98.75%,且无后遗症,术后平均恢复时间最短为6.5 d,且瘢痕平均宽度最窄为3.5 mm;B组效果次之,A组效果最差。3组有效率比较,差异有统计学意义(P＜0.05)。结论 肛瘘切除半深缝合术对多次发作的肛瘘患者疗效最优。     

复杂性肛瘘的中医证型与临床资料及MRI特征的相关性研究

目的:分析复杂性肛瘘的中医证型与临床资料及MRI特征的相关性,为该病的中医辨证分型提供客观依据.方法:收集58例复杂性肛瘘的临床资料及MRI表现,包括性别、年龄、身高、体质量、体质量指数(BMI)、既往脓肿史等,记录患者中医证候及分型.MRI观察主瘘管的信号强度、内口位置、长度、深度及支管信号强度等影像学参数.结果:5...     

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...     

Assessment of anal fistulas with high-resolution subtraction MR-fistulography: comparison with surgical findings

PURPOSE: To investigate a new MR-imaging protocol defined as subtraction MR-fistulography for the detection of fistula-in-ano. MATERIALS AND METHODS: A total of 36 patients (18 men, 18 women) with the clinical diagnosis of anal fistula or abscess who were scheduled for surgical exploration were preoperatively imaged at 1.5 T in the supine position; coronal STIR sequences and axial T1-weighted three-dimensional FLASH sequences before and after intravenous injection of gadobenate dimeglumine (Gd-BOPTA) were obtained. Image subtraction was routinely used. The image findings were compared with the findings at surgical exploration according to a uniform classification system. RESULTS: A total of 46 fistulas were seen on subtraction MR-fistulography, whereas surgery described 41 fistulas. MRI and surgery concordantly depicted a total number of 40 fistulas, six fistulas were only described by MRI, and one fistula was only seen during surgery. A total of 27 abscesses were detected with MRI, compared to 22 during surgery. A total of 22 abscesses were concordantly diagnosed. Complete agreement between subtraction MR-fistulography and surgery occurred in 32 (89%) of the 36 patients. The four patients in whom both procedures disagreed had complex anal sepsis with multiple fistulas and/or abscesses due to Crohn disease. CONCLUSION: High-resolution subtraction MR-fistulography is an important complement to surgical exploration and especially suitable for investigating complex anal sepsis.     

MRI appearance of perianal carcinoma in Crohn's disease

Detection of carcinoma in perianal Crohn's disease can be difficult. The purpose of this study was to describe the MRI appearance of anorectal cancer in patients with perianal Crohn's disease. A total of six patients with anorectal carcinoma (four mucinous adenocarcinoma, two squamous) in Crohn's disease were retrospectively reviewed. Axial T2 and dynamic postcontrast fat-suppressed T1-weighted gradient echo sequences were performed, and findings were compared with 18 noncancer patients with perianal fistulae in Crohn's disease. MRI characteristics of carcinoma were irregular inner wall contours and delayed mild enhancement of internal tissue. The combined features of an irregular internal wall and delayed enhancing tissue were seen exclusively in cancer patients. The four cases of mucinous adenocarcinoma all displayed a pattern of lobulated fluid-filled cavities with delayed internal tissue enhancement. This pattern was not seen in any of the control cases. The presence of a double-layered enhancement pattern was seen in both cases of squamous carcinoma and in only one of four cases of mucinous adenocarcinoma and one of 18 noncancer cases. The pattern of contrast enhancement is valuable in the MRI diagnosis of carcinoma in perianal Crohn's disease.     

Image-guided surgery for anal fistula in a 0.5T interventional MRI unit

PURPOSE: To determine whether MR-guided anorectal surgery is feasible, and to develop techniques for MR-guided anal fistula surgery. MATERIALS AND METHODS: Six patients with pilonidal sinus (PNS), and 21 with suspected anal fistulae were operated on in the GE Signa SPIO 0.5T interventional MRI unit. Procedures were performed with magnet-safe Lockhart-Mummery fistula probes. Preprocedural and intra-operative MRI (IOMRI) techniques were used to identify the extent of the fistula tracts and septic foci, and to ensure the adequacy of the surgical procedure. RESULTS: IOMRI demonstrated the PNS lesions and the adequacy of excision. Imaging failed to demonstrate a fistula in two patients, as confirmed by surgical examination. No images were obtained in one patient due to his size (weight in excess of 100 kg). In 18 patients a fistula tract or abscess was demonstrated and IOMRI was used to assess the adequacy of the surgical procedure. In three patients this demonstrated incomplete drainage of septic foci, which was not obvious on inspection of the surgical field. We believe that in these patients IOMRI prevented an incomplete procedure and the potential requirement for a second operation. Further surgery was performed to rectify this situation. The fistula tract was laid open in 13 patients, and a Seton drain was inserted in five. CONCLUSION: MRI-guided surgery for anal fistula is feasible. IOMRI demonstrates the exact anatomy of the tracts and abscesses, and confirms that all have been adequately treated. We believe it may become particularly useful in surgery for recurrent and complex anal fistulae, and may lead to fewer recurrences.     

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。     

Perfusion-weighted MRI of spinal dural arteriovenous fistula

A 72-year-old woman was admitted with rapidly progressive paraplegia and sphincter disturbance. T2-weighted images of the thoracic spine showed intramedullary high signal with flow voids suggesting dilated medullary veins. Conventional spinal angiography demonstrated a dural arteriovenous fistula draining into perimedullary veins. Perfusion-weighted MRI demonstrated a prolonged mean transit time and increased blood volume in the high-signal area. The loss of normal perfusion gradient and venous hypertension and were thought to produce these differences. The time-to-peak was almost identical in the high-signal and isointense areas, although the bolus of contrast medium arrived earlier in the former. Arteriovenous shunting was thought to cause faster inflow. These changes may have resulted in increased blood volume in the spinal cord. The high signal has been attributed to oedema due to venous congestion, but there has been no histological confirmation. Perfusion MRI in this case supports this hypothesis.