MRI不同序列用于复杂性肛瘘术前诊断的价值

Value of different MRI sequences in preoperative diagnosis of complex anal fistula

目的研究磁共振成像(MRI)不同序列用于复杂性肛瘘术前诊断的价值。方法选择2019年1月至2021年1月我院收治的56例择期拟行手术治疗的复杂性肛瘘患者为研究对象。患者术前均行MRI T_(1)加权成像(T_(1)WI)、T_(2)加权成像(T_(2)WI)序列及T_(1)加权成像压脂(T_(1)WI FS)增强序列检查,术后均证实为复杂性肛瘘。分析术前MRI不同序列诊断复杂性肛瘘分型与手术结果间的一致性。结果56例患者中,经手术共发现括约肌间型31例、经括约肌型17例、括约肌上型5例、括约肌外型3例;T_(1)WI序列检出括约肌间型32例、经括约肌型10例、括约肌上型8例、括约肌外型6例;T_(2)WI序列检出括约肌间型26例、经括约肌型20例、括约肌上型4例、括约肌外型6例;T_(1)WI FS增强序列检出括约肌间型28例、经括约肌型18例、括约肌上型5例、括约肌外型5例。T_(1)WI序列诊断括约肌间型、经括约肌型、括约肌上型、括约肌外型肛瘘与手术结果间的一致性Kappa值分别为0.528、0.570、0.395、0.402;T_(2)WI序列诊断括约肌间型、经括约肌型、括约肌上型、括约肌外型肛瘘与手术诊断间的一致性Kappa值分别为0.539、0.718、0.192、0.402;T_(1)WI FS增强序列诊断括约肌间型、经括约肌型、括约肌上型、括约肌外型肛瘘与手术结果间的一致性Kappa值分别为0.607、0.484、0.780、0.732。结论T_(1)WI、T_(2)WI序列及T_(1)WI FS增强序列在复杂性肛瘘的术前诊断中具有较好的价值,其中T_(1)WI FS增强序列诊断效能更高。

Objective To study the value of different magnetic resonance imaging(MRI)sequences in preoperative diagnosis of complex anal fistula.Methods From January 2019 to January 2021,56 patients with complex anal fistula undergoing elective surgery in our hospital were selected as the research objects.Before operation,all patients were examined with T_(1) weighted imaging(T_(1)WI),T_(2) weighted imaging(T_(2)WI)sequences and T_(1)-weighted imaging fat suppression(T_(1)WI FS)enhancement sequence of MRI,and patients confirmed as complex anal fistula after operation.The consistency between different MRI sequences in preoperative diagnosis of complex anal fistula and surgical results were analyzed.Results Among the 56 patients,31 cases of intersphincteric type,17 cases of transsphincteric type,5 cases of suprasphincteric type and 3 cases of extrasphincteric type were found by surgical.T_(1)WI sequence detected 32 cases of intersphincteric type,10 cases of transsphincteric type,8 cases of suprasphincteric type,and 6 cases of extrasphincteric type.T_(2)WI sequence detected 26 cases of intersphincteric type,20 cases of transsphincteric type,4 cases of suprasphincteric type and 6 cases of extrasphincteric type.T_(1)WI FS enhancement sequence detected 28 cases of intersphincteric type,18 cases of transsphincteric type,5 cases of suprasphincteric type and 5 cases of extrasphincteric type.The consistency Kappa values between T_(1)WI sequence in diagnosis of intersphincteric type,transsphincteric type,suprasphincteric type and extrasphincteric type anal fistulas and surgical results were 0.528,0.570,0.395,and 0.402,respectively.The consistency Kappa values between T_(2)WI sequence in diagnosis of intersphincteric type,transsphincteric type,suprasphincteric type and extrasphincteric type anal fistulas and surgical results were 0.539,0.718,0.192 and 0.402,respectively.The consistency Kappa values between T_(1)WI FS enhanced sequence in diagnosis of intersphincteric type,transsphincteric type,suprasphincteric type and extrasphincteric type anal fistulas and surgical results were 0.607,0.484,0.780,and 0.732,respectively.Conclusion T_(1)WI,T_(2)WI sequences and T_(1)WI FS enhanced sequence have good value for preoperative diagnosis of complex anal fistula,and T_(1)WI FS enhanced sequence has higher diagnostic efficiency.