扩散张量成像定量联合改良Van Assche评分对肛瘘活动性的诊断价值

Value of DTI quantification combined with modified Van Assche index in the diagnosis of anal fistula activity

目的探讨扩散张量成像(DTI)定量联合改良Van Assche评分对肛瘘活动性的诊断价值。方法回顾性分析本院90例肛瘘患者临床、MR资料,分为活动性炎症(PIA)组和非活动性炎症(NIA)组,进行改良Van Assche评分。利用DTI测定主瘘管的各向异性分数(FA)值和表观扩散系数(ADC)值,比较两组改良Van Assche评分、瘘管FA值、ADC值是否存在差异,采用受试者工作特征(ROC)曲线,计算曲线下面积(AUC),利用DeLong检验,分析并比较Van Assche评分、DTI参数(FA值和ADC值)及联合评估对肛瘘活动性的诊断效能。结果PIA组瘘管FA值(0.178±0.018)、ADC值[(0.948±0.138)×10^(-3)mm^(2)/s]小于NIA组[(0.201±0.326)、(1.106±0.086)×10^(-3)mm^(2)/s],PIA组改良Van Assche评分(22.83±3.428)大于NIA组(17.95±3.374)。DTI、改良Van Assche评分及联合评估对肛瘘活动性均具备较高的诊断效能(AUC=0.826、0.798、0.851),其中联合评估诊断效能最优(P<0.05)。DeLong检验示联合评估AUC高于改良Van Assche评分,具有统计学差异(P<0.05),而联合评估与DTI、DTI与改良Van Assche评分的AUC比较无统计学差异(P>0.05)。结论DTI、改良Van Assche评分及联合评估均能有效诊断肛瘘活动性,联合评估能进一步提高肛瘘活动性的诊断效能,而DTI诊断效能与之相当。

Objective To explore the value of diffusion tensor imaging(DTI)quantification combined with modified Van Assche index in the diagnosis of anal fistula activity.Methods The clinical and MR data of 90 patients with anal fistulae in our hospital were retrospectively analyzed,and the modified Van Assche indices were calculated.The fractional anisotropy(FA)and apparent diffusion coefficient(ADC)values of the main fistula were measured on DTI,and the patients were divided into positive inflammation activity(PIA)group and negative inflammation activity(NIA)group.The differences in the modified Van Assche indices,fistula FA and ADC values between the two groups were compared.The diagnostic efficacy of Van Assche index,FA value,ADC value,and combined assessment of anal fistula activity was analyzed using receiver operating characteristic(ROC)curves and the areas under the ROC curves(AUCs)were compared using the DeLong test.Results The fistula FA value(0.178±0.018)and ADC value[(0.948±0.138)×10^(-3)mm^(2)/s]in PIA group were lower than those in NIA group[0.201±0.326,(1.106±0.086)×10^(-3)mm^(2)/s].The modified Van Assche index in PIA group(22.83±3.428)was higher than that in NIA group(17.95±3.374).DTI,modified Van Assche index,and combined assessment had significantly(P<0.05)higher diagnostic efficacy for anal fistula activity(AUC=0.826,0.798,0.851).DeLong test showed that the AUC of the combined assessment was significantly higher than that of the modified Van Assche index(P<0.05)whereas there was no significant difference between the AUCs of the combined assessment and DTI nor between AUCs of DTI and the modified Van Assche index(P>0.05).Conclusion DTI and modified Van Assche index can effectively diagnose anal fistula activity with best diagnostic efficiency using the combined assessment.