DCE-MRI技术在肛瘘患者术前瘘管和瘘口评估中的应用

Application of DCE-MRI in preoperative evaluation of fistula and fistula orifice in patients with anal fistula

目的探讨动态增强磁共振成像(dynamic contrast-enhanced magnetic resonance imaging,DCE-MRI)技术在肛瘘患者术前瘘管和瘘口评估中的应用。方法选取高位复杂型肛瘘患者90例,术前均行DCE-MRI检查,30 min后再行磁共振成像(magnetic resonance imaging,MRI)钆剂瘘管造影+DCE-MRI扫描。以术后病理诊断结果为金标准,分析DCE-MRI的诊断效能。结果DCE-MRI诊断结果显示,高位复杂型肛瘘患者主瘘管91个,>5 mm分支瘘管135个,<5 mm分支瘘管121个,主内瘘口81个,细小内瘘口27个。MRI钆剂瘘管造影+DCE-MRI诊断结果显示,高位复杂型肛瘘患者主瘘管92个,>5 mm分支瘘管137个,<5 mm分支瘘管154个,主内瘘口87个,细小内瘘口103个。DCE-MRI诊断高位复杂型肛瘘患者主瘘管、>5 mm分支瘘管、<5 mm分支瘘管和主内瘘口的准确率分别为97.89%、88.27%、71.62%、85.86%,与手术病理诊断一致性检验的Kappa值分别为0.657、0.436、0.422、0.454(P<0.05);DCE-MRI诊断高位复杂型肛瘘患者细小内瘘口的准确率为29.83%,与手术病理诊断一致性检验的Kappa值为0.040(P>0.05)。MRI钆剂瘘管造影+DCE-MRI诊断高位复杂型肛瘘患者主瘘管、>5 mm分支瘘管、<5 mm分支瘘管、主内瘘口和细小内瘘口的准确率分别为98.95%、89.51%、75.55%、89.90%、71.82%,与手术病理诊断一致性检验的Kappa值分别为0.795、0.467、0.433、0.446、0.380(P<0.05)。结论MRI钆剂瘘管造影联合DCE-MRI技术在高位复杂型肛瘘术前细小分支瘘管及瘘口评估中具有重要应用价值。

Objective To investigate the application of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)in preoperative evaluation of fistula and fistula orifice in patients with anal fistula.Methods A total of 90 patients with high complex anal fistula(HCAF)were selected,DCE-MRI was performed before operation,and magnetic resonance imaging(MRI)was performed 30 min after wards.The results of surgical and pathological diagnosis were taken as the gold standard to analyze its diagnostic efficacy.Results DCE-MRI diagnosis showed 91 primary fistulas,135>5 mm branching fistulas,121<5 mm branching fistulas,81 primary internal fistulas and 27 small internal fistulas in patients with HCAF.MRI gadolinium-fed fistula angiography and DCE-MRI diagnostic results showed that there were 92 main fistulas,137>5 mm branching fistulas,154<5 mm branching fistulas,87 main internal fistulas and 103 small internal fistulas in patients with HCAF.The accuracy rate of DCE-MRI in diagnosing primary fistula,>5 mm branch fistula,<5 mm branch fistula and primary internal fistula in HCAF patients was 97.89%,88.27%,71.62%and 85.86%,respectively,and the Kappa value of consistency test with surgical pathology diagnosis was 0.657,0.436,0.422 and 0.454,respectively(P<0.05).The accuracy rate of DCE-MRI in diagnosing small internal fistulas in patients with HCAF was 29.83%,and the Kappa value of consistency test with surgical pathology diagnosis was 0.040(P>0.05).The accuracy of MRI gadolinium-contrast fistula+DCE-MRI in the diagnosis of primary fistula,>5 mm branch fistula,<5 mm branch fistula,primary internal fistula and small internal fistula in patients with HCAF was 98.95%,89.51%,75.55%,89.90%and 71.82%,respectively,and the Kappa value of consistency test for surgical and pathological diagnosis was 0.795,0.467,0.433,0.446 and 0.380,respectively(P<0.05).Conclusion MRI gadolinium fistulography combined with DCE-MRI technology has an important application value in preoperative evaluation of small branch fistula and fistula orifice of HCAF.