高分辨率MRI多序列成像联合MRVE技术重建在复杂性肛瘘诊断中的应用价值

High-resolution magnetic resonance imaging combined with magnetic resonance virtual endoscopy for the diagnosis of complex anal fistula

目的探讨高分辨率MRI多序列成像联合MRI仿真内窥镜(MRVE)技术重建对复杂性肛瘘的诊断价值。方法回顾性分析我院2018年1月至2020年12月临床诊断为复杂性肛瘘的66例患者的临床及影像学资料。所有患者术前均行高分辨率MRI多序列成像联合MRVE技术重建,并在得到结果后一周内完成手术,将手术所见具体情况与术前的MRI诊断结果对比分析。结果66例患者手术均明确肛瘘诊断,术中共发现主瘘管66支,内口79个,伴发脓肿36例,发现支管34支。依据Parks分型,其中括约肌间型肛瘘38例,经括约肌型肛瘘16例,括约肌上型肛瘘7例,括约肌外型肛瘘5例。以术中探查结果为基准,高分辨率MRI多序列成像及高分辨率MRI多序列成像联合MRVE技术重建检出主瘘管、内口、支管、脓肿及判断Parks分型的准确率分别为90.9%、92.4%、91.7%、82.4%、90.9%和97%、92.4%、100%、93.2%、97%。结论高分辨率MRI多序列成像联合MRVE技术重建是一种可靠的术前评估复杂性肛瘘的检查方法,能较准确显示复杂性肛瘘的主瘘管、内口、支管以及脓肿等情况并明确复杂性肛瘘的Parks分型,可为外科手术方式的选择和预后评估提供详细的形态学依据。

Objectives To explore the value of high-resolution magnetic resonance imaging(MRI)combined with magnetic reso⁃nance virtual endoscopy(MRVE)for the diagnosis of complex anal fistula.Methods This was a retrospective analysis of 66 pa⁃tients with complex anal fistula treated at our hospital between January 2018 and December 2020.All patients underwent highresolution MRI combined with MRVE,and surgeries were performed within one week after the imaging findings.The surgical findings were compared with the MRI diagnosis.Results Anal fistula was confirmed in all 66 patients during surgery.Sixty-six main fistulas,79 internal openings,36 patients with abscesses,and 34 branch fistulas were found during the surgeries.Accord⁃ing to Parks Classification,there were 38 intersphincteric,16 transsphincteric,7 suprasphincteric,and 5 extrasphincteric fistulas.Using the surgical findings as the reference standard,the accuracy for diagnosing main fistula,internal opening,branch fistula,abscess,and Parks Classification were 90.9%,92.4%,91.7%,82.4%,and 90.9%,respectively using high-resolution MRI alone,and 97%,92.4%,100%,93.2%,and 97%,respectively combining high-resolution MRI with MRVE.Conclusion The combina⁃tion of high-resolution MRI with MRVE is a reliable preoperative assessment for complex anal fistula.It can accurately show the main fistula,internal opening,branch fistula,abscess and reliably classify complex anal fistula according to Parks Classifica⁃tion.It can provide detailed morphological assessment for surgical methods selection and prognosis evaluation.