1.5T MRI高分辨T2WI联合动态增强扫描在肛瘘术前诊断中的应用  

Clinical Application of 1.5T MRI high-resolution T2WI combined with dynamic contrast-enhanced scanning in the preoperative diagnosis of anal fistula

作　　者：汪倩倩 余留森 李潮仙 乐雄 卫强 张海燕 徐常宏 WANG Qianqian;YU Liusen;LI Chaoxian;LE Xiong;WEI Qiang;ZHANG Haiyan;XU Changhong(Medical Imaging Center,Nanlang Branch of Zhongshan People's Hospital(Zhongshan Nanlang Hospital),Zhongshan 528454,Guangdong,China)

机构地区：[1]中山市人民医院南朗分院(中山市南朗医院)医学影像中心,广东中山528454

出　　处：《中国现代手术学杂志》2024年第6期509-513,共5页Chinese Journal of Modern Operative Surgery

基　　金：中山市社会公益科技研究项目(2022B1120)。

摘　　要：目的探讨1.5T MRI高分辨T2WI联合动态增强扫描对肛瘘术前诊断的价值。方法选取2022年3月至2023年8月我院收治的50例高度疑似肛瘘的患者,均采用1.5T MRI无间隔薄层高分辨T2WI联合动态增强扫描(联合检查),记录检查结果,并以手术结果为金标准,分析联合检查在肛瘘术前诊断中的应用价值。结果本组50例患者中,联合检查发现肛瘘48例,肛周脓肿2例,术后诊断肛瘘47例,肛周脓肿2例,肛门癌1例。联合检查诊断肛瘘敏感度为100.00%,特异度为66.67%,准确度为98.00%。在T2WI成像中,内口呈点状高信号,主瘘管呈管状高信号,支管呈条索状高信号,脓肿呈马蹄形、泪滴状、不规则形高信号;动态增强扫描示肛瘘内口和瘘管壁明显强化,脓肿壁明显强化,脓液无强化;联合检查对主瘘管、支管、内口、外口、脓肿的准确率分别为93.62%、93.33%、96%、93.18%和100%。47例患者手术检出53个肛瘘瘘管,其中括约肌间型47个,经括约肌型3个,括约肌上型2个,括约肌外型1个,而联合检查发现肛瘘瘘管49个,其中括约肌间型43个,经括约肌型3个,括约肌上型2个,括约肌外型1个,较手术分型漏诊4个括约肌间型瘘管,但分型均正确。结论1.5T MRI无间隔薄层高分辨T2WI联合动态增强扫描能较好显示肛瘘内口、主瘘管、支管及相关脓肿形态特征,对术前肛瘘的诊断及分型评估具有一定价值,值得在临床应用。Objective To assess the clinical application value of 1.5T MRI high-resolution T2-weighted imaging(T2WI)combined with dynamic contrast-enhanced scanning in the preoperative diagnosis of anal fistula.Methods A total of 50 patients with high suspicion of anal fistula admitted to our hospital from March 2022 to August 2023 were enrolled.All patients underwent 1.5T MRI with non-interslice gaps,thinslice high-resolution T2WI combined with dynamic contrast-enhanced scanning(as combined examination).The examination results were recorded,and the surgical outcomes were used as the gold standard to analyze the application value of combined examination in the preoperative diagnosis of anal fistula.Results Among the 50 patients, preoperative combined examination identified 48 cases of anal fistula and 2 cases of perianal abscess.Postoperative diagnosis definitively confirmed 47 cases of anal fistula, 2 cases of perianal abscess, and 1 caseof anal cancer. The sensitivity, specificity and accuracy of the combined examination in the diagnosis of analfistula were 100.00%, 66.67% and 98.00%, respectively. In T2WI imaging, the internal orifice showed punctatehyperintensity, the main fistula showed tubular hyperintensity, the branch showed cord-like hyperintensity, andthe abscess showed horseshoe-shaped, teardrop, and irregular hyperintensity. Dynamic contrast-enhancedscanning revealed that the internal orifice of anal fistula and fistula wall were significantly enhanced, the abscesswall was significantly enhanced, and the pus was not enhanced. The accuracy of combined examination for themain fistula, branch, internal orifice, external orifice and abscess was 93. 62%, 93. 33%, 96%, 93. 18% and100%, respectively. In 47 patients, 53 anal fistulas were detected by surgery, including 47 intersphinctericfistulas, 3 transsphincteric fistulas, 2 suprasphincteric fistulas and 1 extrasphincteric fistula. And 49 analfistulas were found by the combined examination, including 43 intersphincteric fistulas, 3 transsphinctericfistulas, 2 suprasph

关 键 词：肛瘘 1.5T磁共振成像 高分辨率 T2加权成像 动态增强扫描 内口 括约肌外间隙 

分 类 号：R657.16[医药卫生—外科学] R445.2[医药卫生—临床医学]