肛瘘的术前MRI表现与手术结果的对照分析

目的 探讨术前MRI检查对肛瘘诊断及分型的价值.方法 回顾性分析经手术证实的36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 36例肛瘘手术显示内口42个,主瘘管45条、瘘管分支15条,外口42个,脓肿16个.与手术结果对照,MRI显示肛瘘内口的准确率为90.5%(38/42个),显示瘘管分支的准确率为80%(12/15条),显示主瘘管、外口及脓肿的准确率均为100%.按照Parks分型,MRI分型符合率为88.9%(32/36例).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。     

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.     

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.     

360°环阵经直肠腔内超声对肛瘘的价值

目的探讨经直肠新型360°环阵腔内超声对肛瘘的诊断价值。方法收集2014年6月~2015年5月期间肛瘘患者64例,术前超声Parks分型与术后手术记录Parks分型对照。结果经直肠腔内超声能清晰显示内外括约肌。手术64例患者中,41例单纯性肛瘘,23例为复杂性肛瘘,其中括约肌间型29例,经括约肌型17例,扩约肌上型10例,括约肌外型8例。64例肛瘘共86个原发瘘管,89个内口,80个外口,42个肛周脓肿,超声对原发瘘管、肛周脓肿、内口显示的灵敏度分别为89.5%、100%和88.2%,特异度分别为91.5%、97.5%、86.3%。结论 360°经直肠腔内超声诊断肛瘘具有简便、实时、易操作等特点,能清楚显示内外括约肌,能为术前肛瘘的准确定位提供极有帮助的影像学信息,从而具有较高临床价值。     

MRI在肛瘘诊治中的应用

目的 :探讨3.0 T MRI在肛瘘检查及分类中的应用。方法 :选择经手术证实的53例肛瘘患者,行MRI检查包括T1WI,T2WI,T2SPAIR,PDWI SPAIR序列。由2位经验丰富的MRI诊断医师进行图像阅片,并对肛瘘进行分类。结果 :MRI发现瘘管60个,脓肿38个,内口56个,术中发现瘘管62个,脓肿39个,内口59个。MRI发现瘘管的敏感度和特异度分别为96.8%(60/62),88.2%(15/17);脓肿为97.4%(38/39),93.3%(14/15);内口为94.9%(56/59),85.0%(17/20)。结论:MRI检查能够很好地确定肛瘘范围及脓肿内口位置,并对肛瘘进行正确分类,为手术提供依据。     

360°环阵经直肠腔内联合经会阴超声对肛瘘的诊断价值

目的 :探讨360°环阵经直肠腔内联合经会阴超声对肛瘘的诊断价值。方法 :将150例肛瘘患者随机分为试验组和对照组各75例,试验组采用360°环阵经直肠腔内联合经会阴超声进行术前评估,评估内容包括肛瘘主支的Parks分型、内口、瘘管主管、支管及有无慢性脓腔;对照组在手术开始前从外口注入1%亚甲蓝液着色以初步了解瘘管位置、走行及内口情况,比较2组手术符合率。结果:试验组超声检查肛瘘主支的Parks分型结果括约肌间型94.7%(36/38)、经括约肌型89.3%(25/28)、括约肌外型66.7%(2/3)、括约肌上型83.3%(5/6)。2组各类型肛瘘的诊断符合率差异有统计学意义(P0.05)。2组术前诊断内口位置、肛瘘分支差异均有统计学意义(均P0.05)。结论:360°环阵经直肠腔内联合经会阴超声对肛瘘的诊断具有较高应用价值,对肛瘘手术有重要的指导作用。     

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,...     

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.     

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。     

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。     

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.     

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     

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.     

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。     

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.