MRI常规序列联合DWI、增强扫描序列用于肛瘘术前诊断的价值研究

MRI conventional sequences combined with DWI and LAVA-enhanced sequence for preoperative diagnosis of anal fistulas

目的探讨3.0T MRI常规序列联合弥散加权成像(DWI)序列和肝脏三维容积快速成像(LAVA)增强扫描用于肛瘘术前诊断的价值。方法回顾性选取2021年5月至2023年6月温州市中西医结合医院收治的行手术治疗肛瘘患者78例。患者均于术前1周内进行3.0T MRI检查。以手术结果为金标准,分析术前MRI常规序列、DWI序列、LAVA增强序列、常规+DWI+LAVA增强序列对肛瘘的诊断价值,包括比较不同序列对肛瘘内口、主瘘管、分支瘘管及脓腔的显示情况,评估MRI诊断肛瘘Parks分型与手术结果之间的一致性;根据瘘管有无脓液将患者分为无脓液(14例)、有脓液(36例)、伴有脓腔(28例)3类,比较3类患者主瘘管表观弥散系数(ADC)值的差异。结果MRI常规序列、DWI序列、LAVA增强序列、常规+DWI+LAVA增强序列对内口、主瘘管的显示情况比较差异均有统计学意义(均P<0.05),常规及LAVA增强序列优于DWI序列(均P<0.05);对分支瘘管、脓腔的显示情况比较差异均无统计学意义(均P>0.05)。MRI对肛瘘Parks分型诊断与手术结果一致性较好(Kappa=0.769,P<0.05)。无脓液患者与有脓液、伴有脓腔患者的主瘘管ADC值比较差异有统计学意义(均P<0.05),而有脓液患者与伴有脓腔患者的主瘘管ADC值比较差异无统计学意义(P>0.05)。结论3.0T MRI常规序列联合DWI、LAVA增强序列在显示肛瘘内口、主瘘管中有优势,且能较准确诊断肛瘘Parks分型,ADC值有助于术前判定病灶有无活动性炎症。MRI可作为术前协助临床诊断肛瘘的一种有效影像学检查方法。

Objective To explore the value of conventional sequences combined with diffusion weighted image(DWI)and liver acceleration volume acquisition(LAVA)-enhanced sequence of 3.0T magnetic resonance imaging(MRI)in preoperative diagnosis of anal fistulas.Methods Seventy-eight patients with anal fistula undergoing surgical treatment in Wenzhou Integrated Traditional and Western Medicine Hospital from May 2021 to June 2023 were included in the study.All patients had an 3.0T MRI examination within 1 week before surgery.With surgical results as the gold standard,the preoperative diagnosis value of conventional sequences,DWI,LAVA enhanced sequence,and the combination of three methods were analyzed.It included that the images of internal openings,main fistula,branch fistula and abscess formation were compared and the consistency between MRI diagnosis and surgical results was evaluated.According to surgical findings patients were divided into three kinds:no-pus(n=14),pus(n=36)and concomitant abscess(n=28).The apparent diffusion coefficient(ADC)of the main fistula for the three were compared.Results There were significant differences in display of internal openings and main fistula among 3 methods alone and their combination(P<0.05),the conventional sequences and LAVA-enhanced sequence were superior to DWI sequence(P<0.05);while there were no significant differences in display of branch fistula and abscess formation among three methods(P>0.05).The MRI Parks'classification of anal fistula was consistent with the surgical results(Kappa=0.769,P<0.05).The ADC of no-pus was significant different with that of pus and concomitant abscess(P<0.05),but there was no significant difference in ADC between pus and concomitant abscess(P>0.05).Conclusion The conventional sequences combined with DWI and LAVA-enhanced sequence of 3.0T magnetic resonance imaging has advantages in displaying the internal openings and main fistula of anal fistula,and can accurately diagnose Parks'classification of anal fistula;and ADC value is helpful to show inflammation,indicating that it may be used as an effective imaging method to assist clinical diagnosis of anal fistula before surgery.