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.     

高频彩色多普勒超声在肛周脓肿、肛瘘的应用价值

目的探讨高频彩色多普勒超声诊断肛周脓肿与肛瘘的临床应用价值。方法使用高频彩色多普勒超声对90例肛周脓肿或肛瘘患者进行检查,并将检查结果与手术结果对照。结果肛周脓肿与肛瘘的声像图与周围正常组织有明显的区别,对肛周脓肿的诊断特异度、阳性预测均是100%,灵敏度为94.3%;对肛瘘的诊断特异度与阳性预测值分别为95.1%、95.5%,灵敏度为85.7%。结论高频彩色多普勒超声检查对肛周脓肿的位置、大小、数目、范围及肛瘘瘘管的走行、数目具有很高的诊断价值,且方便、直接、无痛苦、诊断准确、易被患者接受。     

Assessment of hyperemia in acute appendicitis: Comparison between power Doppler and color Doppler sonography

The purpose of our study was to compare power Doppler sonography (US) and conventional color Doppler US in the diagnosis of acute appendicitis by revealing local signs of hyperemia. One hundred consecutive patients (46 males and 54 females, ages 7–61 years; mean, 24.7 years) with clinically suspected acute appendicitis were prospectively examined with power Doppler US and conventional color Doppler US. Of 38 patients who subsequently underwent surgery, appendicitis was proven in 34. The remaining 62 patients who were not submitted to surgery had no clinical evidence of appendicitis over a 2- to 6-month follow-up. At gray-scale US, the appendix was visualized in 30 (88.2%) of the 34 cases with pathologically proven acute appendicitis. Power Doppler US depicted a moderate to marked hypervascularity of the appendiceal wall and surrounding mesoappendix in 28 (93.3%) of these 30 patients. At conventional color Doppler US, flow signal within the appendiceal wall and surrounding mesoappendix was shown in only 21 (70%) of 30 cases (P<0.05). No false-positive diagnosis was made at either power or color Doppler US among the 62 patients without appendicitis. Power Doppler US is more sensitive than conventional color Doppler imaging for revealing signs of local hyperemia in acute appendicitis.     

Color Doppler imaging of posttraumatic priapism before and after selective embolization.

High-flow priapism usually follows perineal or penile trauma with disruption of an intracavernosal artery. Angiographic embolization of the lacerated artery is currently considered the treatment of choice. The contribution of gray-scale and color Doppler ultrasonography (US) in diagnosis and treatment of 10 patients with high-flow priapism was investigated. In patients with recent arterial laceration, the cavernous tissue surrounding the arterial-sinusoidal fistula appears as a hypoechoic region with undefined margins. In long-standing priapism, this area is usually more regular and circumscribed, mimicking a pseudoaneurysm. Color Doppler US is highly sensitive for detection of the arterial-sinusoidal fistula that causes extravasation of blood from the lacerated cavernosal artery. After angiography, color Doppler US allows confirmation of both successful embolization by demonstrating disappearance or size reduction of the fistula and unsuccessful treatment by demonstrating patency of collateral feeding vessels or early recanalization of the embolized artery. Limitations of color Doppler US include underestimation of the number of accessory feeding vessels, which may become patent only after embolization of the main vascular supply, and difficulty in recognizing vessels that feed the fistula from the opposite side.     

Magnetic resonance imaging evaluation of perianal fistula

Aim of work

To clarify the role of MRI in diagnosis and classification of perianal fistula and to evaluate the additional clinical value of preoperative MR imaging and its benefit to surgeon.

Methods

This prospective study contained 25 patients (21 males and 4 females; age range 10–60 years; mean age 34.8 years) selected from 40 patients referred to the Radiodiagnosis department with perianal sepsis, the study was conducted between October 2009 and September 2011, MRIs were performed and the results were ensured by surgical results, sensitivity, specificity and predictive values of MRIs were determined.

Results

25 patients with perianal sepsis were included in this study, 3 cases grade 1 (simple linear intersphincteric fistula), 2 cases grade 2 (intersphincteric fistula with abscess or secondary track), 9 cases grade 3 (trans-sphincteric fistula), 9 cases grade 4 (trans-sphincteric fistula with abscess (5 cases), secondary track within the ischiorectal fossa (3 cases) and both (1 case)) and 2 cases grade 5 (supralevator and translevator disease one case for each).

Conclusion

MRI is a useful procedure for successful management of peri-anal fistula by correct assessment of the extent of disease and relationship to sphincter complex. Also it helps in identification of secondary extensions, particularly horseshoe tracts and abscesses resulting in complete evaluation and highest possible diagnostic accuracy aiding successful surgical interventions, aiming to reduce complications and recurrences.     

Vesico-ureteral reflux: diagnosis and staging with voiding color Doppler US: preliminary experience

INTRODUCTION: The aim of this study is to assess the accuracy of a new US examination: 'voiding color Doppler US ' in the early diagnosis and staging of vesico-ureteral reflux (VUR). The contrast agent US was SH U 508A (Levovist, Schering, Berlin), which produces a chromatic accentuation of the signals picked up by the color Doppler US. Eighteen patients (10 females, eight males) were recruited for the study. In two patients a second examination was performed for follow-up after a VUR conservative therapy. All patients were taken under examination for the evaluation of possible VUR. In all patients the voiding color Doppler US was followed by voiding cystourethrography (VCUG) and the data obtained were compared. MATERIALS AND METHODS: A total of 18 patients aged between 3 months and 10 years, were recruited for the study. The results of the examination were the following: urinary tract infections, follow-up of VUR after conservative or surgical therapy, miscellaneous indications. Voiding color Doppler US was performed, followed by a VCUG. The voiding color Doppler US consists in the trans-catheter introduction of a contrast agent SHU 508 A (Levovist, Schering, Ag. Berlin) into the bladder and a subsequent test with the color Doppler US to show or exclude the presence of reflux into the ureters and/or into the pyelo-caliceal cavity of the kidneys. After the introduction of the contrast agent US the ultrasound scanning of the bladder, the ureters and the pyelo-caliceal cavity was performed to examine the reflux degree. The ultrasonographic investigations were perfomed with AU 590 asyncronus US (Esaote Biomedica, Genova) with a 3.5 MHz convex probe. RESULTS: After the trans-catheter introduction of the contrast agent US, vesico-ureteral reflux occured in 13 patients (77.2%). The reflux degree was also measured by means of ultrasound and was later confirmed by VCUG. The mean times of each examination were as follows: initial US, 10 min; catheterization, 8 min; voiding color Doppler US, 15 min; overall VCURG examination 10 min. The overall mean duration of the voiding color Doppler US examination was 33 min. The comparable mean time for VCUG, including the catheterization time, was 20 min. No reactions of intolerance to the ultrasound contrast agent occurred. DISCUSSION AND CONCLUSIONS: The voiding color Doppler US test has evidenced in all patients the presence of the contrast agent US in the bladder after the introduction. In 13 patients (77.2%) with presence of VUR, the voiding color Doppler US test has established the reflux degree confirmed by cystourethrography. The superimposability of the data obtained with voiding color Doppler US and VCUG would seem to confirm the importance of this new ultrasonographic technique in the diagnosis and staging of VUR.     

高频浅表与腔内探头联合应用对肛周脓肿手术的指导价值

目的探讨联合应用高频浅表小器官探头及经直肠腔内探头超声检查对肛周脓肿手术的指导价值。方法回顾性分析经手术治疗且术前超声检查的110例肛周脓肿患者的临床资料。以手术结果为依据,比较高频浅表联合腔内探头与单纯应用高频浅表探头对肛周脓肿的检查情况及术后治愈情况。结果单纯应用高频浅表探头患者53例,其中,对脓肿合并肛瘘、瘘管内口位置诊断符合率分别为73．8％（31／42）、57．1％（24／42）,一次性手术治愈率为64．2％;高频浅表联合腔内探头患者57例,对脓肿合并肛瘘、瘘管内口位置诊断符合率为94．5％（52／55）、90．9％（50／55）,一次性手术治愈率为93．0％。联合超声检查与单纯浅表超声探头检查比较,不论是脓肿合并肛瘘、瘘管内口位置诊断符合率还是一次性手术治愈率,差异均具有统计学意义（P〈0．05）。结论高频浅表与腔内探头联合应用对肛周脓肿手术具有较高的指导价值。     

Appendicitis in children: color Doppler sonography.

The authors used color Doppler ultrasonography (US) to evaluate 33 children with suspected appendicitis and found locally increased blood flow in all of 10 patients with appendicitis or periappendiceal abscess; the studies were normal in 16 patients without appendicitis. The gray-scale sonographic results were concordant in all 26 of these patients. In two other patients with presumptive mesenteric adenitis and in one patient with a hemorrhagic ovarian cyst at gray-scale US, color Doppler imaging showed no increased perfusion and aided in confirming the absence of a significant inflammatory process. In four other children, color Doppler US clarified gray-scale sonographic findings that might have been confused with complicated appendicitis and aided in the diagnosis of other causes of acute abdominal pain. These findings indicate that color Doppler US is a useful adjunct to gray-scale US in evaluating children with suspected acute appendicitis.     

Clinical examination, endosonography, and MR imaging in preoperative assessment of fistula in ano: comparison with outcome-based reference standard

PURPOSE: To prospectively evaluate the relative accuracy of digital examination, anal endosonography, and magnetic resonance (MR) imaging for preoperative assessment of fistula in ano by comparison to an outcome-derived reference standard. MATERIALS AND METHODS: Ethical committee approval and informed consent were obtained. A total of 104 patients who were suspected of having fistula in ano underwent preoperative digital examination, 10-MHz anal endosonography, and body-coil MR imaging. Fistula classification was determined with each modality, with reviewers blinded to findings of other assessments. For fistula classification, an outcome-derived reference standard was based on a combination of subsequent surgical and MR imaging findings and clinical outcome after surgery. The proportion of patients correctly classified and agreement between the preoperative assessment and reference standard were determined with trend tests and kappa statistics, respectively. RESULTS: There was a significant linear trend (P < .001) in the proportion of fistula tracks (n = 108) correctly classified with each modality, as follows: clinical examination, 66 (61%) patients; endosonography, 87 (81%) patients; MR imaging, 97 (90%) patients. Similar trends were found for the correct anatomic classification of abscesses (P < .001), horseshoe extensions (P = .003), and internal openings (n = 99, P < .001); endosonography was used to correctly identify the internal opening in 90 (91%) patients versus 96 (97%) patients with MR imaging. Agreement between the outcome-derived reference standard and digital examination, endosonography, and MR imaging for classification of the primary track was fair (kappa = 0.38), good (kappa = 0.68), and very good (kappa = 0.84), respectively, and fair (kappa = 0.29), good (kappa = 0.64), and very good (kappa = 0.88), respectively, for classification of abscesses and horseshoe extensions combined. CONCLUSION: Endosonography with a high-frequency transducer is superior to digital examination for the preoperative classification of fistula in ano. While MR imaging remains superior in all respects, endosonography is a viable alternative for identification of the internal opening.     

Magnetic Resonance Imaging Evaluation of Perianal Fistulas

Purpose

The purpose of this study was to discuss the usefulness of magnetic resonance imaging in evaluating perianal fistulas, their ramifications, extent, associated abscesses and relations with the anal sphincter complex and its role in preoperative classification.

Material & methods

A retrospective study was carried out using picture archiving and communication system. Data of 58 patients presented with a clinical suspicious of perianal fistula from April 2012 to March 2013 was collected. In all patients pre contrast T2 propeller with and without fat suppression, diffusion weighted and pre and post contrast liver acceleration volume acquisition sequences were obtained. Pulse sequences were as follows: T2 propeller (TR: 7766 ms, TE: 122 ms), Diffusion weighted (TR: 7000 ms, TE: 67 ms), LAVA (TR: 7 ms, TE: 3.242 ms).

Results

MRI revealed a total number of 38 fistulae in 35 (60%) patients while 13 (22%) patients had only perianal sinuses. Out of these 35 patients, 4 were females and 31 were male subjects. Out of total 38 fistulae seen in these 35 patients, 11 (29%) were transsphincteric, 24 (63%) were intersphincteric and 2 (5%) were suprasphincteric. Only 1 (3%) case was extrasphincteric fistula. Twenty-six fistulae (68%) were simple, whereas 12 (32%) showed associated abscess formation, inflammation and branching course.

Conclusion

Our results support that MRI is the method of choice for evaluating perianal fistulae as they display the anatomy of the sphincter muscles orthogonally with a background of good contrast resolution. Moreover, with MRI we can accurately classify perianal fistulas preoperatively along with the detection of associated infection and help in planning a successful surgery.     

Predictors of prostate carcinoma: accuracy of gray-scale and color Doppler US and serum markers

PURPOSE: To determine the accuracy of detecting prostate cancer by using (a) gray-scale and color Doppler transrectal ultrasonography (US), (b) serum and excess prostate-specific antigen (PSA) levels, and (c) targeted and sextant transrectal US-guided biopsy. The relationship between US-detected neovascularity and tumor biologic activity was also evaluated. MATERIALS AND METHODS: Between 1995 and 1999, 544 patients with elevated PSA levels and/or abnormal digital rectal examination underwent transrectal US-guided sextant biopsy and targeted biopsy of US abnormalities. Sensitivity, specificity, and accuracy of gray-scale US, color Doppler US, targeted biopsy, and PSA and excess PSA were calculated. RESULTS: Gray-scale US depicted 78 (41.1%) of 190 cancers, whereas color Doppler US depicted 30 (15.8%) additional cancers. Targeted biopsy was used to detect 108 (56.8%) cancers, whereas sextant biopsy was used to detect 82 (43.2%) additional cancers. Although US-visible cancers had a higher Gleason grade than did cancers discovered at sextant biopsy (P <.05), 25 of the 66 cancers identified with sextant biopsy alone were Gleason grade 6 or higher. Color Doppler US-depicted hypervascularity correlated with biologically aggressive tumors. Excess PSA was normal in 58 (30.5%) cancers, with an accuracy of 67.3%, resulting in better prediction of prostate tumors than with serum PSA level alone. CONCLUSION: Gray-scale transrectal US, even coupled with color Doppler US, is inadequate for prostate carcinoma screening; therefore, targeted biopsy should always be accompanied by complete sextant biopsy sampling.     

Evaluation of perianal sepsis: comparison of anal endosonography and magnetic resonance imaging

The purpose of this study was to compare prospectively the diagnostic yield of anal endosonography (AES) and magnetic resonance imaging (MRI) in the assessment of perianal fistulae and abscesses. There were 39 patients (14 men, 25 women; mean age, 40 years) who underwent AES, performed with a 10-MHz rotating endoanal probe and MRI at 1.0 T (axial and coronal T2-weighted turbo spin-echo (TSE) and turbo-STIR sequences). Fistulae were classified as subcutaneous, intersphincteric, transsphincteric, high (i.e., high extrasphincteric or suprasphincteric), rectovaginal, and horseshoe and were compared with the surgical findings in all patients. Overall, 58 fistulae (subcutaneous, N = 7; intersphincteric, N = 9; transsphincteric, N = 16; high, N = 17; rectovaginal, N = 5; and horseshoe, N = 4) were detected at surgery. MRI showed a sensitivity of 84% and AES of 60% (P <.05). False-positive diagnoses were made in 6 patients (15%) with MRI and in 15 patients (26%) with AES, for a specificity of 68% and 21%, respectively (P <.05). Our findings show that MRI is superior to AES in the assessment of fistula-in-ano before major surgery. AES should be used only for orientation before minor procedures, such as incision or drainage of subcutaneous fistulae.     

CT imaging with fistulography for perianal fistula: does it really help the surgeon?

ObjectiveTo prospectively evaluate the relative accuracy of computed tomography (CT) fistulography for preoperative assessment of fistula in ano.Materials and MethodsEthical committee approval and informed consent were obtained. A total of 22 patients (15 male and 7 female, age 21–58 years) who were suspected of having fistula in ano underwent preoperative CT fistulography (CTF). The CT images of 0.6 mm were obtained respectively before and after fistulography; contrast-enhanced CT scan was also performed in 22 patients. CTF images were evaluated by two expert radiologists to assess the fistulas in the following respects: (a) the volume-rendered imaging; (b) the extensions of active inflammatory tissue; (c) the internal opening and external opening; (d) the hidden areas of tract or abscess; and (e) the deep abscess adjacent to fistula. CT findings in 18 patients were compared with surgical findings or exam under anesthesia.ResultsThe CTF findings in 18 cases were basically in accordance with the surgical findings and/or examination findings under anesthesia. Both coronal and transverse planes were useful in assessing the location and direction of tracts or abscesses. Complicated spatial information within the perianal soft tissue about the fistula with secondary ramifications or abscesses can be easily demonstrated to the surgeons. Contrast-enhanced images were useful in assessing the inflammatory lesion activity and infiltrated area.ConclusionCTF exquisitely depicts the perianal anatomy and shows the fistulous tracks with their associated ramifications, enables selection of the most appropriate surgical treatment, and therefore minimizes all chances of recurrence.     

The Use of Contrast-Enhanced Color Doppler Ultrasound in the Differentiation of Retinal Detachment from Vitreous Membrane

Objective

To compare the clinical utility of contrast-enhanced color Doppler US in the differentiation of retinal detachment (RD) from vitreous membrane (VM) with that of various conventional US modalities, and to analyze the enhancement patterns in cases showing an enhancement effect.

Materials and Methods

In 32 eyes examined over a recent two-year period, RD (n=14) and VM (n=18) were confirmed by surgery (n=28) or clinical follow-up (n=4). In all cases, gray-scale, color Doppler, and power Doppler US were performed prior to contrast injection, and after the intravenous injection of Levovist (Schering, Berlin) by hand for 30 seconds at a dose of 2.5 g and a concentration of 300 mg/mL via an antecubital vein, contrast-enhanced color Doppler US was performed. At Doppler US, the diagnostic criterion for RD and VM was whether or not color signals were visualized in membranous structures.

Results

Diagnostic accuracy was 78% at gray-scale US, 81% at color Doppler US, 59% at power Doppler US, and 97% at contrast-enhanced color Doppler US. The sensitivity of color Doppler US to color signals in RD increased from 57% to 93% after contrast enhancement.The enhancement patterns observed were signal accentuation (n=3), signal extension (n=2), signal addition (n=3), and new signal visualization (n=5).

Conclusion

Contrast-enhanced color Doppler US was the most accurate US modality for differentiating RD from VM, showing a significantly increased signal detection rate in RD.     

Indications of inflammation visualized by ultrasound in osteoarthritis of the knee

PURPOSE: Ultrasound examination of a group of patients with osteoarthritis (OA) of the knee for signs of inflammation. MATERIAL AND METHODS: 71 knees in 71 patients with osteoarthritis of the knee were examined with high-resolution gray-scale ultrasound combined with color and spectral Doppler. The medial, lateral, and antero-superior compartments were examined. Hyperemia was identified as presence of color Doppler signals in the synovial membrane. Low resistance flow was defined as a resistive index < 0.80 on spectral Doppler. RESULTS: Synovial thickening was found in all knees; fluid in 61 patients; and hyperemia (color Doppler activity) in 51 patients. Of these, 44 had arterial flow on spectral Doppler - 36 with a low resistance flow. When present, fluid and color Doppler activity was found in all three compartments, but with uneven distribution. CONCLUSION: The finding in the majority of cases of both effusions on B-mode US and Doppler activity confirms that there is a varying degree of inflammation in knee OA as diagnosed by the ACR criteria.     

医源性肠外瘘的分型和CT表现

目的:探讨医源性肠外瘘的分型和CT表现.方法:对754例医源性肠外瘘实施了CT检查.参照临床分型,将肠外瘘分为管状瘘、唇状瘘和断端瘘三个类型,并分析其CT征象.结果:管状瘘所占比例最高(占68.70%),表现为内、外口之间不均匀的管道形成;唇状瘘(占31.30%)的CT征象特点是较大的外口,呈唇状改变,无瘘管形成.管状瘘的腹腔和腹膜后脓肿发生率明显高于唇状瘘(P＜0.01),而唇状瘘的肠壁炎性改变发生率较高(P＜0.01).结论:CT检查能够显示医源性肠外瘘的临床分型,对治疗具有指导性作用.     

Testicular tumors: findings with color Doppler US.

A study of 28 patients with surgically proved testicular tumors was performed to determine the appearance at color Doppler ultrasound (US) scanning. There was a general correlation of tumor size and vascularity. Twenty of 21 (95%) tumors larger than 1.6 cm were hypervascular. Six of seven (86%) tumors smaller than 1.6 cm were hypovascular. One small, 1.1-cm-diameter seminoma was hypervascular, and one 2.8-cm-diameter seminoma was hypovascular. The histologic findings of the tumor did not correlate with the vascularity of the lesion as seen at color Doppler US. Resistive indexes ranged from .476 to 1.0 (mean, 0.70). Peak systolic velocities ranged from 8.4 cm/sec to 64.9 cm/sec (mean, 9.8 cm/sec). Venous flow was detected in eight tumors. The gray-scale findings, as well as history and physical examination findings, correctly suggested a neoplasm in all cases. The findings at color Doppler US were prospectively interpreted as indicative of neoplasm in 27 cases and as indicative of inflammation in one case. The authors conclude that color Doppler US scanning has only a limited role in the evaluation of testicular tumors.     

Typical MR imaging findings of perianal infections in patients with hematologic malignancies

ObjectiveWe aimed to investigate the MR imaging findings of patients with hematologic malignancies who have symptoms suggesting perianal infection and to demonstrate the importance of imaging.Subjects and methodsThe study included 36 patients with hematologic malignancies who underwent anorectal MR imaging in our department between September 2011–May 2016. Two radiologists experienced in abdominal radiology viewed the MR images in consensus. Abscesses, fistulous or sinus tracts, signal alterations and contrast enhancement in keeping with an inflammation and edema in the perianal region were recorded.ResultsPerianal abscess was found in 16 of the 36 patients. In 10 of these 16 patients there was also extensive inflammatory signal alterations in perianal and/or perineal soft tissues.In six of the 36 patients perianal fistula was detected. A sinus tract was seen at the level of subcutaneous external anal sphincter in one patient. Inflammatory signal alterations in the surrounding soft tissues were present in three of these seven patients.There were abscesses in labium majus in two patients and in one patient there were perineal abscesses with accompanying inflammatory signal alterations.In six of the 36 patients no abscess or fistula/sinus tract was seen. There were only inflammatory signal alterations with contrast enhancement in perianal or subcutaneous tissues.In two patients presenting with perianal pain and hemorrhoids, minimal inflammatory changes were detected on MR images.There were two patients with normal MR imaging findings.ConclusionAs digital examination of the anorectum and rectoscopy are avoided in neutropenic patients, MR imaging, which clearly demonstrates the perianal pathology should be preferential.     

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。     

肛门直肠周围脓肿、肛瘘的磁共振诊断与应用价值

目的:探讨磁共振成像在肛门直肠周围脓肿、肛瘘诊断中的临床应用价值。方法:回顾性分析2008年9月~2010年3月经病理证实的58例肛门直肠周围脓肿/肛瘘患者,其中男性肛周脓肿12例,肛瘘30例,女性肛周脓肿6例,肛瘘10例。病例均于术前行常规盆腔磁共振检查,其中40例行增强检查,扫描序列包括矢状、冠状T2WI,轴位T1WI、T2WI,轴位T2脂肪抑制序列,增强轴位、矢状脂肪抑制T1WI序列。术前诊断与手术及病理结果对照。结果:58位患者,术前磁共振发现脓肿24个,瘘管40条,内口32个;4例内口及5例支瘘管漏诊。结论:磁共振检查对肛门直肠周围脓肿、肛瘘诊断及明确脓肿、肛瘘位置、数目,累及范围、瘘管走行及其与周围结构关系具有很高的应用价值。