基于耦合剂造影三维容积内插屏气检查(3D-VIBE)动态增强技术诊断直肠阴道瘘

目的 探讨基于超声耦合剂造影三维容积内插屏气检查（3D-VIBE）动态增强（DCE）MRI对直肠阴道瘘（RVF）的诊断价值。方法 回顾性分析23例经手术或肠镜证实的RVF患者，术前均接受MR检查，扫描前分别向肛管、阴道灌入适量超声耦合剂，而后采集矢状位、冠状位和轴位T1WI、轴位T2WI、轴位脂肪抑制T2WI、DWI和3D-VIBE DCE-MRI，记录瘘口数量、开口位置、瘘管支数及周围软组织病变情况，并与手术及肠镜结果进行对比。结果 23例患者中，12例经手术治疗，11例接受肠镜检查，共发现26个瘘口、27支瘘管，6例合并周围脓肿，3例存在放射状损伤。超声耦合剂造影+3D-VIBE DCE-MRI对于瘘口、瘘管的显示率及诊断周围脓肿、放射性损伤的准确率均高于各常规序列（P均<0.05）。结论 基于超声耦合剂造影3D-VIBE DCE-MRI对RVF诊断价值较高。

Three-dimensional volumetric interpolated breath-hold examination dynamic contrast-enhanced MRI based on ultrasonic couplant in diagnosis of rectovaginal fistula

Objective To explore the value of three-dimensional volumetric interpolated breath-hold examination (3D-VIBE) dynamic contrast-enhanced MRI(DCE-MRI) based on ultrasonic couplant in diagnosis of rectovaginal fistula (RVF). Methods Twenty-three patients with RVF confirmed by surgery or colonoscopy who underwent MR scanning before operation were retrospectively analyzed. Before scanning, appropriate amount of ultrasound coupling agent was injected from the anal canal and vagina. Then sagittal, coronal and transverse T1WI, transverse T2WI, transverse fat suppression T2WI, DWI and 3D-VIBE DCE images were acquired. The number of opening of fistulas, position of openings, number of fistulas tubes and soft tissue lesions were recorded, and the results were compared with those of surgery or colonoscopy. Results Among 23 patients, 12 underwent surgical operations and 11 underwent colonoscopy. Totally 26 openings of fistulas and 27 fistula tubes were detected, while 6 cases were found with peripheral abscess and 3 cases with radiation injury. The diagnostic accuracy rate for the opening of fistula, fistula tube and peripheral abscess and radiation injury of DCE-MRI 3D-VIBE with ultrasonic couplant were higher than those of conventional MR sequences (all P<0.05). Conclusion Based on ultrasonic couplant, 3D-VIBE DCE-MRI had high diagnostic value for RVF.