磁共振LAVA技术在复杂性肛瘘内口诊断中的应用价值

Value of LAVA sequence for the diagnosis of complex anal fistula

目的探讨LAVA技术在复杂性肛瘘内口中的应用价值。方法回顾性分析24例经复杂性肛瘘患者MRI表现。每位患者序列分成2个组合:A组:肛管轴位T1WI、T2WI、压脂、DWI;冠状位T2WI;矢状位T2WI;B组:A组序列+LAVA序列;以手术记录为金标准,计算2序列组合诊断内口的敏感性、特异性、阳性预测值(positive predictive value,PPV)、阴性预测值(negative predictive value,NPV),用卡方检验比较不同组诊断的准确性。结果 A、B组合诊断肛瘘内口的敏感性分别是73.9%vs 91.3%,特异性72%vs 8%,PPV:70.8%vs 87.5%、NPV:70.5%vs 91.7%,P=0.04。两位医生对内口位置诊断一致性较好(0.80>K(A、B、C、D)>0.60)。结论 LAVA技术联合平扫序列可提高MRI诊断复杂性肛瘘内口的准确性。

Objective To evaluate the value of LAVA sequence combined with the routine MRI sequences in displaying the internal openings in complex anal fistulae. Methods 24 cases of complex anal fistula were collected. The MRI images： each patient＇s MRI sequences were divided into two groups： Group A： axial T1 WI,T2WI,axial STIR; human body axial DWI; coronal T2WI; sagittal T2WI; Group B： axial T1 WI,T2WI,axial STIR; human body axial DWI; coronal T2WI; sagittal T2WI; LAVA sequence; Taken the surgical exploration results as gold standard,the sensitivity,specificity,positive predictive value,negative predictive value of the internal opening were compared using Chi-squaer Test. Using the unweighted Kappa test methods,agreement between the two observers was evaluated. Results The sensitivity of group A,B,in detecting internal openings was 73. 9%vs 91. 3%,the specificity was 72% vs 88%,PPV was 70. 8% vs 87. 5%,NPV was 70. 5% vs 91. 7%. The two observers had good agreement in group A,B,C,D（ 0. 80 K（ A、B、C、D） 0. 60）. Conclusion LAVA sequence combined with routine MRI sequences can improve the diagnosis value of internal opening of complex fistula.