糖尿病患者肛管直肠周围感染的MRI影像表现

MRIfindingsofperianorectalinfectionindiabeticpatients

摘要:

目的：探讨糖尿病患者肛周感染的MRI影像表现。方法：回顾性分析重庆市中医院2009年9月至2017年12月在放射科接受肛管直肠磁共振成像的300例糖尿病伴发肛周不适患者的MRI图像，由2位具有丰富盆底磁共振诊断经验的放射科医师对肛周炎症、脓肿、臀部皮下脂肪间隙炎症、腺源性肛瘘（肛瘘分型及主瘘管位置、主内瘘口位置、分支瘘管数目、外瘘口情况、外口距肛垂直线距离）、窦道、动态增强信号改变、非腺源性肛瘘进行分析并进行记录。结果：300例中241位患者存在盆底信号异常改变，主要表现为肛管炎症、肛管内黏膜增厚、血管增粗、痔伴感染、肛周脓肿、会阴蜂窝组织炎或脓肿、臀部蜂窝组织炎或脓肿、腺源性肛瘘（Parks分型）、非腺源性肛瘘或上述征象共同存在，其中肛周血管增粗、痔疮及肛管炎212例；臀部皮下脂肪间隙炎症157例；肛管直肠周围间隙脓肿132例，其中脓肿沿肛管向上累及直肠黏膜下间隙及直肠黏膜周围间隙8例、局限于肛管后括约肌间后深间隙脓肿17例、沿肛管后深间隙播散至肛周26例、穿破外括约肌向前下播散至会阴患者27例、穿透外括约肌向后下至臀部皮下脂肪间隙22例、未穿破括约肌沿括约肌间向臀裂播散23例，沿上述2个或3个途径广泛播散患者9例；形成肛瘘患者144例，其中98例为单纯型肛瘘，包括41例括约肌间肛瘘、22例经括约肌瘘、16例括约肌外型肛瘘、10例括约肌上肛瘘、9例Parks无法分型，46例为复杂性肛瘘，包括25例括约肌间型伴有经括约肌型肛瘘、11例括约肌上型伴括约肌间型肛瘘、3例存在括约肌上型伴经括约肌型伴括约肌间型、7例无法分型；主瘘管共89支，其中位于括约肌间走行41例、穿破肛管及外括约肌向坐骨肛管窝走行22例、穿破肛管向上走行于括约肌间隙而后穿破外括约肌进入坐骨肛管窝内16例、位于括约肌上10例；分支瘘管共138支，其中延伸至直肠黏膜周围或直肠黏膜下间隙32支、括约肌间隙64支、肛管后深间隙42支；图像形态学表现为动态增强后瘘管及内瘘口呈早期明显强化、DWI对脓肿显示敏感呈稍高信号、脓肿伴周围感染呈明显强化、瘘管壁多呈延迟强化、纤维型内瘘口呈延迟强化。结论：糖尿病患者肛周感染十分常见，MRI对糖尿病患者肛周病变提供精确诊断。

Abstract:

Objective：ToinvestigatetheMRIfindingsofperianalinfectionindiabeticpatients.Methods：AretrospectiveanalysiswasperformedontheMRIfilmsof300diabeticpatientswithperianaldiscomfortswhounderwentMRIexaminationoftheanusandrec－tuminourhospitalfromSeptember2009toDecember2017；thefollowingwereanalyzedandrecordedbytworadiologistsexperi－encedintheMRIdiagnosisofpelvicdiseases：perianalinflammation，perianalabscess，glutealfatpadinflammation，glandularanalfistula（fistulatypeandmainfistulalocation，maininternalfistulalocation，branchfistulanumber，externalfistulastatus，distancebe－tweentheexternalapertureandtheverticallineoftheanus），sinus，dynamiccontrast-enhancedsignalchange，non-glandularanalfistula.Results：Abnormalsignalchangesinthepelvicfloorwerefoundin241ofthe300cases，includinganalcanalinflammation，thickeningofmucousmembraneintheanalcanal，vasculardilation，hemorrhoidswithinfection，perianalabscess，perinealcellulitisorabscess，glutealcellulitisorabscess，glandularanalfistula（Parkstype），non-glandularanalfistula，orco-existenceoftheabovemani－festations；amongthese，therewere212casesofperianalvascu－lardilation，hemorrhoids，andanalcanalinflammation，157cas－esofglutealfatpadinflammation，132casesofperianorectalspaceabscess（including8casesofabscessinvolvingsuperiorlythespacebelowandaroundtherectalmucosa，17casesofab－scesslocalizedwithintheposteriordeepspacebetweentheposterioranalsphincters，26casesofabscessspreadingtoperi－analareasalongtheposteriordeepspaceoftheanalcanal，27casesofabscessspreadinganterioinferiorlytotheperineumafterperfo－ratingtheexternalsphincter，22casesofabscessspreadingposterioinferiorlytotheglutealfatpadafterperforatingtheexternalsphincter，23casesofabscessspreadingalongtheinter-sphincterspacetotheglutealcleftduetofailuretoperforatethesphincters，and9casesofabscesswidelyspreadingalongtheabovetwoorthreepaths）；moreover，therewere144casesofanalfistula，ofwhich，98weresimplefistula（including41casesofinter-sphincterfistula，22casesoftrans-sphincterfistula，16casesofextra-sphinc－terfistula，10casesofsuperior-sphincterfistula，and9casesofParkstypeundefined），and46werecomplexfistula（including25casesofinter-sphincterfistulawithtrans-sphincterfistula，11casesofsuperior-sphincterfistulawithinter-sphincterfistula，3casesofsuperior-sphincterfistulawithtrans-sphincterfistula，and7casesoffistulaundefined）.Therewere89mainfistulas（41casesspreadingwithinthesphincters，22casesspreadingtotheischioanalfossaafterperforatingtheanalcanalandexternalsphincter，16casesspreadingsuperiorlywithintheinter-sphincterspaceafterperforatingtheanalcanal，andthenintotheischioanalfossafollow－ingperforatingtheexternalsphincter，and10casesspreadingabovethesphincter），and138branchfistulas（32branchesextendingtothespacearoundorbelowtherectalmucosa，64branchesextendingtotheinter-sphincterspace，and42branchesextendingtotheposteriordeepspaceoftheanalcanal）.Themorphologicalfeatureswereasfollows：markedearlyenhancementforthefistulaandinternalfistulaorificeafterdynamicenhancement，slighthyperintensityofabscessonDWI，markedenhancementforabscesswithperipheralinfections，mostlydelayedenhancementforthefistulawall，anddelayedenhancementforthefibrousinternalfistulaorifice.Conclusion：Perianalinfectionisverycommonindiabeticpatients.MRIprovidesaccuratediagnosisforperianallesionsindiabeticpatients.