两种MRI脂序列诊断肛瘘内口的准确性比较
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摘要
目的比较磁共振成像(MRI)质子密度加权像(PDWI)与增强T1加权像(T1WI)抑脂序列诊断肛瘘内口的准确性,以提高肛瘘诊治效果。方法选取2015年1月至2017年12月东莞仁康医院收治的40例经手术病理证实为肛瘘的患者,术前均接受MRI检查,以术中病理结果为准,对比MRI PDWI抑脂序列与增强T1WI抑脂序列诊断肛瘘内口的准确性。结果 40例患者手术病理共确诊内口58个;增强T1WI抑脂序列提示内口57个,真阳性55个;PDWI抑脂序列提示内口55个,真阳性53个。两种序列对内口的诊断敏感度、阳性预测值对比,差异均无统计学意义(均P> 0.05)。两种序列诊断对术中病理确诊内口的诊断具有中等一致性(Kappa=0.465,P <0.001)。增强T1WI抑脂序列的显示效果分级高于PDWI抑脂序列(P <0.05)。结论 PDWI抑脂序列和增强T1WI抑脂序列均能够在术前有效定位肛瘘内口,且后者对内口的显示效果相对较好。
Objectives To compare accuracy between Proton Density Weighted Imaging(PDWI) PFS sequence and T1 weighted image(T1WI) Spectral Presaturation with Inversion Recovery(SPIR) enhanced sequence in diagnosing internal opening of fistula,in order to improve efficacy of diagnosis and treatment of fistula. Methods 40 patients with fistula who were treated in Dongguan Renkang Hospital between January 2015 and December 2017 were recruited as study subjects. All patients were diagnosed with fistula through surgery and pathological examinations. All patients received MRI before surgery. We used pathological examination as reference to compare accuracy between PDWI PFS sequence and T1WI SPIR enhanced sequence in diagnosing internal opening of fistula. Results A total of 58 internal openings were diagnosed using pathological examination in 40 patients. T1WI SPIR enhanced sequence showed 57 internal openings, with true positive of 55. PDWI PFS sequence showed 55 internal opening, with true positive of 53. There was no significant difference between the two sequences in sensitivity and positive predictive value(P > 0.05). Diagnostic agreement of the two sequences referenced to pathological examinations was median(Kappa = 0.465,P < 0.001). T1WI SPIR enhanced sequence had significant better grading of the view than PDWI PFS sequence(P < 0.05). Conclusion PDWI PFS sequence and T1WI SPIR enhanced sequence could both effectively determine internal openings of fistula before surgery, and the later has better view.
Objectives To compare accuracy between Proton Density Weighted Imaging(PDWI) PFS sequence and T1 weighted image(T1WI) Spectral Presaturation with Inversion Recovery(SPIR) enhanced sequence in diagnosing internal opening of fistula,in order to improve efficacy of diagnosis and treatment of fistula. Methods 40 patients with fistula who were treated in Dongguan Renkang Hospital between January 2015 and December 2017 were recruited as study subjects. All patients were diagnosed with fistula through surgery and pathological examinations. All patients received MRI before surgery. We used pathological examination as reference to compare accuracy between PDWI PFS sequence and T1WI SPIR enhanced sequence in diagnosing internal opening of fistula. Results A total of 58 internal openings were diagnosed using pathological examination in 40 patients. T1WI SPIR enhanced sequence showed 57 internal openings, with true positive of 55. PDWI PFS sequence showed 55 internal opening, with true positive of 53. There was no significant difference between the two sequences in sensitivity and positive predictive value(P > 0.05). Diagnostic agreement of the two sequences referenced to pathological examinations was median(Kappa = 0.465,P < 0.001). T1WI SPIR enhanced sequence had significant better grading of the view than PDWI PFS sequence(P < 0.05). Conclusion PDWI PFS sequence and T1WI SPIR enhanced sequence could both effectively determine internal openings of fistula before surgery, and the later has better view.
引文
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[12]张莲,蔡卫东,孙希文.MRI肛瘘内口诊断在治疗中的价值:磁共振PDWI抑脂与增强T1WI抑脂序列的对照研究[J].中国医学计算机成像杂志,2016,22(5):435-439.
[13]吕茜婷,高知玲,李珊玫,等.3.0T磁共振多序列成像在复杂肛瘘诊断中的临床应用[J].中国医学计算机成像杂志,2016,22(4):331-335.
[14]王军大,李映.MRI诊断复杂性肛瘘的临床应用价值[J].重庆医学,2014,43(34):4626-4627,4630.
[2]LIANG C,LU Y,ZHAO B,et al.Imaging of anal fistulas:comparison of computed tomographic fistulography and magnetic resonance imaging[J].Korean J Radiol,2014,15(6):712-723.
[3]彭杰.30例肛瘘患者不同序列扫描MR诊断分析[J].中国CT和MRI杂志,2017,15(8):128-130.
[4]王晓鹏,付志辉,吴本升,等.高分辨率磁共振成像在复杂性肛瘘诊疗中的应用价值[J].结直肠肛门外科,2015,21(5):360-362.
[5]BAIK J,KIM S H,LEE Y,et al.Comparison of T2-weighted imaging,diffusion-weighted imaging and contrast-enhanced T1-weighted MR imaging for evaluating perianal fistulas[J].Clin Imaging,2017,44:16-21.
[6]杨建荣,毛小明,蒋廷宠,等.低场磁共振不同成像序列在肋软骨损伤中的应用比较[J].中华全科医学,2015,13(1):100-101,111.
[7]ZUBAIDI A M.Anal fistula.Past and present[J].Saudi Med J,2014,35(9):937-944.
[8]LIMURA E,GIORDANO P.Modern management of anal fistula[J].World J Gastroenterol,2015,21(1):12-20.
[9]王丹,汤献忠.MRI在肛瘘诊断中的应用价值(附381例报告)[J].结直肠肛门外科,2014,20(1):61-62.
[10]TOLAN D J.Magnetic Resonance Imaging for Perianal Fistula[J].Semin Ultrasound CT MR,2016,37(4):313-322.
[11]龚志刚,杨烁慧,朱琼,等.质子加权预饱和脂肪抑制序列在肛瘘中的应用价值[J].临床放射学杂志,2012,31(3):386-389.
[12]张莲,蔡卫东,孙希文.MRI肛瘘内口诊断在治疗中的价值:磁共振PDWI抑脂与增强T1WI抑脂序列的对照研究[J].中国医学计算机成像杂志,2016,22(5):435-439.
[13]吕茜婷,高知玲,李珊玫,等.3.0T磁共振多序列成像在复杂肛瘘诊断中的临床应用[J].中国医学计算机成像杂志,2016,22(4):331-335.
[14]王军大,李映.MRI诊断复杂性肛瘘的临床应用价值[J].重庆医学,2014,43(34):4626-4627,4630.