肛瘘的高分辨率MRI特征与其中医辨证分型的相关性研究

TCM syndrome differentiation of anal fistula and its correlative study with high resolution MRI characteristics

目的:分析肛瘘的高分辨率MRI特征与中医辨证分型之间的关系。方法:收集61例经手术证实的肛瘘患者的临床及影像学资料。根据中医辨证分型,将61例分为湿热下注型、正虚邪恋型和阴液亏虚型。3组均行高分辨率MRI T_(1)WI、脂肪抑制T_(2)WI与DWI扫描。观察内口位置、有无脓肿、瘘管数量,测量瘘管的ADC值,并对瘘管进行分级。结果:61例中,湿热下注型41例、正虚邪恋型18例和阴液亏虚型2例。湿热下注型与正虚邪恋型、阴液亏虚型瘘管平均ADC值比较,差异均有统计学意义(均P<0.05)。高分辨率MRI脂肪抑制T_(2)WI对瘘管及内口的诊断敏感度分别为86.49%(64/74)、87.69%(57/65)。结论:肛瘘高分辨率MRI特征与其中医辨证分型具有相关性,ADC值可为肛瘘的中医辨证分型提供参考,并为中医内治、外治提供依据。

Objective:To study the relationship of high resolution MRI characteristics and TCM syndrome classification of anal fistula.Methods:Clinical data and image findings of 61 patients with anal fistula were analyzed retrospectively.According to clinical TCM syndrome classification,61 patients were divided into 3 types,syndrome of dampness-heat diffusing downward,syndrome of lingering pathogen due to deficient vital qi and syndrome of consumption of yin-fluid.All patients underwent high resolution MRI T_(1)WI,fat suppression T_(2)WI and DWI scan.The position of anal fistula,the presence of abscess and the number of fistula were observed.ADC values of fistula were measured.And the fistulas were graded.Results:Of all 61 patients,41 cases were syndrome of dampness-heat diffusing downward,18 cases were syndrome of lingering pathogen due to deficient vital qi and 2 cases were syndrome of consumption of yin-fluid.ADC value of fistula in syndrome of lingering pathogen due to deficient vital qi and syndrome of consumption of yin-fluid had significant difference with that in syndrome of dampness-heat diffusing downward(both P<0.05).The sensitivity of high resolution MRI fat suppression T_(2)WI for detecting anal fistula and internal opening was 86.49%(64/74)and 87.69%(57/65).Conclusions:High resolution MRI features of anal fistula are correlated with different TCM syndrome types,ADC value can provide reference information for TCM syndrome differentiation of anal fistula and provide reference basis for internal and external treatment of TCM.