磁共振时间-信号强度曲线联合ADC值在评估肛瘘活动性方面的价值研究

The value of time-signal intensity curve of magnetic resonance imaging combined with apparent diffusion coefficient in the evaluation of anal fistula activity

目的探索1.5T磁共振(magnetic resonance imaging,MRI)时间-信号强度曲线(time-signal intensity curve,TIC)联合表观扩散系数(apparent diffusion coefficient,ADC值)在评估肛瘘活动性方面的价值。方法回顾性分析宁波市鄞州第二医院2018年6月至2020年2月经手术病理证实的肛瘘患者71例的临床、影像及病理资料,依据手术所见、病理组织成分为金标准,将患者分为活动期组(42例)和缓解期组(29例),采用交叉表Pearsonχ^(2)检验对两组的TIC类型进行分析,并比较两组的ADC值。结果TIC类型:活动期组Ⅰ型(流入型)[47.6%(20/42)]、Ⅲ型(流出型)[35.7%(15/42)]均显著高于Ⅱ型(平台型)[16.7%(7/42)](χ^(2)=9.22、3.94,均P<0.05);缓解期组Ⅰ型(流入型)[34.5%(10/29)]、Ⅱ型(平台型)[55.2%(16/29)]均高于Ⅲ型(流出型)[10.3%(3/29)](χ^(2)=4.86、13.23,均P<0.05);ADC值测定:活动期组[(0.932±0.074)×10^(-3) mm^(2)/s]明显低于缓解期组[(1.164±0.061)×10^(-3) mm^(2)/s](t=-13.87,P<0.001)。结论磁共振动态TIC联合ADC值能有效评估肛瘘活动性,可以作为肛瘘术前评估及术后随访的常规检查序列加以推广。

Objective To evaluate the value of time-signal intensity curve(TIC)combined with apparent diffusion coefficient(ADC)obtained with 1.5T magnetic resonance imaging in the evaluation of anal fistula activity.Methods The clinical,imaging,and pathological data of 71 patients with pathologically confirmed anal fistula who received treatment in Ningbo Yinzhou No.2 Hospital from June 2018 to February 2020 were retrospectively analyzed.These patients were divided into active phase group(n=42)and remission phase group(n=29)according to surgical findings and pathological tissue composition.Pearson's chi-square test was used to analyze TIC types.The ADC value was compared between the two groups.Results TIC types:In the active phase group,the percentage of patients with type I curve(rising enhancement pattern)and type III curve(washout pattern)was 47.6%(20/42)and 35.7%(15/42)respectively,which were significantly higher than that of patients with type III curve[plateau pattern;16.7%(7/42),χ^(2)=9.22,3.94,both P<0.05].In the remission phase group,the percentage of patients with type I and II curves was 34.5%(10/29)and 55.2%(16/29)respectively,which were significantly higher than that of patients with type III curve[10.3%(3/29),χ^(2)=4.86,13.23,both P<0.05].ADC value:ADC value in the active phase group was significantly lower than that in the remission phase group[(0.932±0.074)×10^(-3) mm^(2)/s vs.(1.164±0.061)×10^(-3) mm^(2)/s,t=-13.87,P<0.001].Conclusion TIC combined with ADC value can effectively evaluate anal fistula activity.It can be used as a routine method for preoperative evaluation and postoperative follow-up for patients with anal fistula.