T1-Vibe-FS与T1-Flash-SPAIR动态增强序列联合钆剂瘘管造影在肛瘘诊断中的应用价值  

The value of T1-Vibe-FS and T1-Flash-SPAIR dynamic contrast-enhanced sequences combined with gadolinium fistulography in the diagnosis of anal fistula

作　　者：姜阳 刘莹莹 王军大 张德川 彭聪 余万军 陈玉洪[1] JIANG Yang;LIU Yingying;WANG Junda;ZHANG Dechuan;PENG Cong;YU Wanjun;CHEN Yuhong(Department of Radiology,Chongqing Traditional Chinese Medicine Hospital,Chongqing 400021,China)

机构地区：[1]重庆市中医院放射科,重庆400021

出　　处：《磁共振成像》2021年第8期65-70,共6页Chinese Journal of Magnetic Resonance Imaging

基　　金：成都中医药大学2019年度“杏林学者”医院专项(编号:YYZX2019082);重庆科卫联合医学科研重点项目(编号:2019ZDXM022)。

摘　　要：目的探讨T1-Vibe-FS与T1-Flash-SPAIR动态增强序列联合钆剂瘘管造影在肛瘘诊断中的应用价值。材料与方法使用Siemens Avanto 1.5 T超导磁共振成像系统,80例经手术证实均为肛瘘的患者术前均行MRI扫描。先行矢状位、冠状位和横断位扫描,后随机行T1-Flash-SPAIR-dyn、T1-Flash-SPAIR-dyn+钆剂瘘管造影、T1-Vibe-FS-dyn、T1-Vibe-FS-dyn+钆剂瘘管造影(依次记为S1、S2、S3、S4组)动态增强扫描。测量并计算信噪比(signal-to-noise ratio,SNR)和对比噪声比(contrast-to-ratio,CNR),对比4种扫描方法的SNR、CNR和内口截石位点分布差异;对内口位置、肛瘘原发瘘管数量、分支瘘管数量、脓肿以及Parks分型进行分析,比较不同扫描序列的影像诊断结果与手术结果的符合率。结果T1-Vibe-FS-dyn序列比T1-Flash-SPAIR序列可以获得较高的SNR和CNR,4种扫描方法的SNR(P<0.05)和CNR(P<0.05)差异有统计学意义,内口截石位点分布有差异(P<0.05);4种扫描方法对内口位置(P=0.676)、原发瘘管数量(P=1.000)、分支瘘管数量(P=0.377)、脓肿(P=0.230)和Parks分型(P=0.712)的影像诊断与手术结果符合率差异无统计学意义,但扫描方法对Parks诊断分型有特异性(P<0.05)。结论对有外漏口的患者采用方法S4可以获得较高的SNR和CNR,对无外漏口的患者采用方法S3可以获得较高的SNR和CNR;方法S1可更好地诊断Parks分型为未定型,方法S2可更好地诊断Parks分型为括约肌上型,方法S3、S4可更好地诊断Parks分型为括约肌外型。Objective:To evaluate the value of T1-Vibe-FS and T1-Flash-SPAIR dynamic contrast-enhanced sequences combined with gadolinium fistulography in the diagnosis of anal fistula.Materials and Methods:Siemens Avanto 1.5 T superconducting MRI system was used.Eighty patients with anal fistula confirmed by operation were scanned by MRI before operation.Sagittal,coronal and transverse scans were performed at first,followed by dynamic enhanced scans of T1-Flash-SPAIR-dyn,T1-Flash-SPAIR-dyn(combined gadolinium fistulography),T1-Vibe-FS-dyn and T1-Vibe-FS-dyn(combined gadolinium fistulography)(S1,S2,S3,S4).The signal-to-noise ratio(SNR)and contrast-to-ratio(CNR)were measured and calculated,and the differences of SNR,CNR and internal orifice lithotomy sites were compared among the four scanning methods.The location of internal orifice,the number of primary anal fistula,the number of branch fistula,abscess and Parks classification were analyzed.In addition,the coincidence rate of imaging diagnosis results of different scanning sequences with surgical results was compared.Results:Compared with T1-Flash-SPAIR sequence,T1-Vibe-FS-dyn sequence could obtain higher SNR and CNR.There were statistical differences in SNR(P<0.05)and CNR(P<0.05)of the four scanning methods.In addition,there was significant difference in the distribution of lithotomy sites in internal mouth(P<0.05).There was no difference in the coincidence rate between the four scanning methods in the diagnosis of internal orifice position(P=0.676),the number of primary fistula(P=1.000),the number of branch fistula(P=0.377),abscess(P=0.230)and Parks classification(P=0.712).However,the scanning method was specific for Parks diagnosis(P<0.05).Conclusions:Higher SNR and CNR can be obtained in patients with external leakage by method S4.Higher SNR and CNR can be obtained by method S3 in patients without external leakage.Method S1 can better diagnose Parks classification as undefined,method S2 can better diagnose Parks classification as suprasphincter type,method S3 and S4 can

关 键 词：肛瘘 磁共振成像 瘘管造影 动态增强 钆 

分 类 号：R445.2[医药卫生—影像医学与核医学] R574.8[医药卫生—诊断学]