直肠注水多模态MRI高分辨扫描可用于肛瘘患者术前诊断  

Rectal water injection multi-modal MRI high resolution scan can be used for preoperative diagnosis of patients with anal fistula

作　　者：赵梦文 汤永祥[2] 葛军[3] 李石坚[2] 张冉[2] 洪丹丹 程慧 袁伟民 张一帆 ZHAO Mengwen;TANG Yongxiang;GE Jun;LI Shijian;ZHANG Ran;HONG Dandan;CEHNG Hui;YUAN Weimin;ZHANG Yifan(Graduate School,Bengbu Medical University,Bengbu 233004,China;Department of Medical Imaging,Tongling People's Hospital,Tongling 244000,China;Department of Proctology,Tongling People's Hospital,Tongling 244000,China)

机构地区：[1]蚌埠医科大学研究生院,安徽蚌埠233004 [2]铜陵市人民医院医学影像中心,安徽铜陵244000 [3]铜陵市人民医院肛肠科,安徽铜陵244000

出　　处：《分子影像学杂志》2024年第11期1195-1199,共5页Journal of Molecular Imaging

基　　金：中国红十字基金会“医学赋能-领航菁英科研项目”(XM_LHJY2022_05_06)。

摘　　要：目的探讨直肠注水多模态MRI高分辨扫描在肛瘘诊断中的应用价值。方法选取2022年10月~2024年1月经本院拟诊为肛瘘的患者进行MR检查,先行MRI常规序列扫描,直肠注水后再行同样序列及动态增强MRI(DCE-MRI)检查,比较各常规序列上瘘管以及瘘管与邻近括约肌关系清晰度,选出最优序列;在最优序列上做注水前后瘘管长度、瘘管最大直径及瘘管内口直径变化的对比分析,并比较瘘管的检出率。结果41例经手术及病理证实的肛瘘患者中共有67个瘘管。注水前T1WI、压脂T2WI、三维翻转恢复快速自旋回波(3D-STIR-TSE)序列以及注水后DCE-MRI对瘘管以及瘘管与邻近括约肌关系清晰度的差异均有统计学意义(P<0.05),以3D-STIR-TSE序列最具优势。3D-STIR-TSE序列直肠注水前、后对瘘管长度、瘘管最大直径、瘘管内口直径两两比较的差异均有统计学意义(P<0.05);注水前、后瘘管清晰度对比中,注水前检出率为89.55%(60/67),注水后检出率为98.51%(66/67),二者差异有统计学意义(P=0.04)。结论在多模态MRI对肛瘘诊断检查中,以3D-STIR-TSE序列最优;直肠注水多模态MRI检查操作简单,可提高瘘管的诊断能力,是常规MRI检查的重要补充。Objective To preliminarily investigate the application value of multi-modal MRI high-resolution scanning with rectal water instillation in the diagnosis of anal fistula.Methods Patients who were diagnosed with anal fistula in our hospital from October 2022 to January 2024 were selected for MR examinations.More specifically,following routine MRI sequence scanning,these patients received the same sequence scanning and dynamic contrast-enhanced MRI(DCE-MRI)examinations after rectal water instillation.In this foundation,this research further compares the clarity of fistulas as well as the relationship between fistulas and adjacent sphincters in each conventional sequence,thereby identifying the optimal sequence.Furthermore,this research compares the changes in fistula length,the maximum diameter of fistulas,the internal orifice diameter of fistulas and the detection rate of fistula before and after rectal water instillation in the optimal sequence.Results A total of 67 fistulas were observed in 41 patients with anal fistula confirmed by surgery and pathology.Specifically,T1WI,T2WI,three-dimensional spin echo with short time inversion recovery(3D-STIR-TSE)sequences before rectal water instillation as well as DCE-MRI sequence after rectal water instillation exhibited significant differences in the clarity of fistulas and the relationship between fistulas and adjacent sphincters(P<0.05),among which 3D-STIR-TSE sequence performed best.Further analysis of 3D-STIR-TSE sequence demonstrated that there were statistical differences in the length,maximum diameter,and internal orifice diameter of fistulas before and after rectal water instillation(P<0.05).Moreover,regarding the contrast of the clarity of fistulas before and after rectal water instillation,the detection rate of fistulas before rectal water instillation was 89.55%,whereas that after rectal water instillation increased to 98.51%.The difference between them was statistically significant(P=0.04).Conclusion 3D-STIR-TSE sequence achieves the optimal performance in the

关 键 词：直肠注水 MRI 高分辨率成像 肛瘘 瘘管 

分 类 号：R445.2[医药卫生—影像医学与核医学] R657.16[医药卫生—诊断学]