MRI钆剂瘘管造影与DCE-MRI联合使用对高位复杂型肛瘘细小分支瘘管及瘘口的诊断价值

Value of MRI Ga fistulography combined with DCE-MRI in the diagnosis of high complex anal fistula with small branch fistula and orificium fistulae

摘要:

目的：MRI钆剂瘘管造影与动态对比增强磁共振成像（dynamic contrast enhanced MRI，DCE-MRI）联合使用，对高位复杂型肛瘘进行诊断，探讨其对高位复杂型肛瘘术前评估的指导意义。方法：收集2014年12月10日至2016年12月10日MRI平扫初步证实为高位复杂型肛瘘但细小内瘘口、分支瘘管显示不清的患者264例，首先行DCE-MRI检查，30 min后再行瘘管内注入钆特酸葡胺4 mL+生理盐水16 mL造影检查同步DCE-MRI扫描。分别对MRI平扫、DCE-MRI及瘘管造影+DCE-MRI诊断结果特异度及敏感度行约登指数、ROC曲线下面积（AUC）进行检验。结果：瘘管造影+DCE-MRI示高位复杂型肛瘘外瘘口、内瘘口及分支瘘管显示清晰，瘘管T1WI、T2WI上呈高信号；脓肿为不规则形或马蹄状，T1WI等、稍低信号，T2WI、脂肪抑制高信号。对照手术结果，瘘管造影+DCE-MRI对于术前诊断对于细小内瘘口及细小分支瘘管的诊断价值明显提高；MRI平扫对于细小瘘管显示约登指数为31.60%，曲线形面积为0.576，对于细小内瘘口约登指数为-23.70%，曲线形面积为0.176；DCE-MRI对于细小瘘管显示约登指数为69.40%，曲线形面积为0.603，对于细小内瘘口约登指数为-4.80%，曲线形面积为0.201；瘘管造影+DCE-MRI对于细小瘘管显示约登指数为87.80%，曲线形面积为0.798，对于细小内瘘口约登指数为79.50%，曲线形面积为0.898。结论：钆剂瘘管造影与DCE-MRI联合使用检查对临床高位复杂型肛瘘的术前评估具有较高指导意义。

Abstract:

Objective：To diagnoze complex high anal fistula by combined use of MRI Ga fistula radiography and dynamic contrast enhanced MRI（DCE-MRI） and to explore its guiding significance for the diagnosis and treatment of high complex anal fistula. Methods：MRI confirmed 264 cases of high complex anal fistula complicated with small internal fistula，and uncleared branch fistula form December 10，2014 to December 10，2016. DCE-MRI check was firstly performed，than DCE-MRI and GA-DTPA 4 mL+ saline 16 mL in the fistula was soon performed through injection. Youden index and AUC test were performed to test the specificity and sensitivity of the results. Results：Fistulography+DCE-MRI clear displayed fistulography of high complex fistula，external fistula，branch fistula，and fistula T1WI；T2WI showed high signal. Abscess was irregular or horseshoe shaped，T1WI，slightly low signal，T2WI，high signal of fat suppression. The control results of surgery showed that fistulography+DCE-MRI obviously increased the diagnostic value for small fistula and small branch fistula. MRI scan for small fistula showed that Youden index was 31.60%，curve area was 0.576；MRI scan for small branch fistula showed that Youden index was -23.70%，and curve area was 0.176. DCE-MRI for small fistula showed that Youden index was 69.40% and curve area was 0.603；DCE-MRI for small branch fistula showed that Youden index was -4.80% and curve area was 0.201. Fistulography+DCE-MRI for small fistula showed that the Youden index was 87.80%，and curve area was 0.798；fistulography+DCE-MRI for small branch fistula showed that Youden index was 79.50% and curve area was 0.898. Conclusion：Fistulography+DCE-MRI have high clinical significance in the diagnosis and treatment of high complex anal fistula.