Evaluation of MRI priority examination sequence for acute infection around the rectum and anus
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摘要:
目的 分析直肠肛管周围急性期感染MRI检查的优先检查，从而提高检查成功率。 方法 回顾性分析75例直肠肛管周围急性期感染患者的MRI表现，与手术对照，比较各序列或序列组合的诊断率，统计能够完成诊断的优先序列和序列组合，探讨其诊断价值。 结果 40例（53.3%）仅需斜轴位抑脂快速自旋回波（FSE）T2WI一个序列即可完成诊断，33例（40%）需斜轴位抑脂FSE T2WI序列+斜轴位不抑脂FSE T2WI序列或斜轴位不抑脂FSE T1WI两个序列完成诊断，1例（1.3%）需斜轴位抑脂FSE T2WI序列+斜冠状位抑脂FSE T2WI序列3D重建完成诊断，1例（1.3%）需斜轴位抑脂FSE T2WI序列+斜轴位扩散加权成像序列完成诊断。 结论 斜轴位抑脂FSE T2WI序列是直肠肛管周围急性期感染的最基本序列；病灶定位不明确时需增加扫描斜轴位不抑 脂FSE T2WI序列或斜轴位不抑脂FSE T1WI序列，可以在较短时间内完成大多数急性期感染的诊断，总扫描时间6~7 min；少数瘘管形态复杂的患者，需要扫描斜冠状位抑脂FSE T2WI序列并行3D重建；内口显示欠清的个别情况，可以尝试扩散加权成像序列。 Abstract:Objective To analyze and summarize the superior sequences of MRI examination for acute infection around the rectum and anorectal canal, give priority to examination, and thus improve the success rate of examination. Methods The MRI manifestations of 75 patients with acute infection around the rectum and anorectal canal were retrospectively analyzed. The diagnostic rates of each sequence or sequence combination were compared with those of surgery. The priority sequences and sequence combinations that could complete the diagnosis were counted, and their diagnostic values were summarized. Results In 40 cases (53.3%), only one sequence of oblique axial fat- suppressed fast spin echo (FSE) T2WI was needed to complete the diagnosis. In 33 cases (40%), two sequences of oblique axial fat-suppressed FSE T2WI sequence and oblique axial non-fat-suppressed FSE T2WI sequence or oblique axial non-fat-suppressed FSE T1WI were needed to complete the diagnosis. In 1 case (1.3%), oblique axial fat-suppressed FSE T2WI sequence and oblique coronal fat-suppressed FSE T2WI sequence 3D reconstruction was needed to complete the diagnosis. In 1 case (1.3%), oblique axial fat- suppressed FSE T2WI sequence and oblique axial diffusion- weighted imaging sequence needed to complete the diagnosis. Conclusion The oblique axial fat-suppressed FSE T2WI sequence is the most basic sequence for acute infection around the rectum and anal canal. When the location of the lesion is unclear, it is necessary to add the oblique axial non-fat-suppressed FSE T2WI sequence or the oblique axial non-fat-suppressed FSE T1WI sequence, which can complete the diagnosis of most acute infections in a short time, with a total scanning time of 6-7 min. A small number of patients with complex fistula morphology need to scan the oblique coronal fat-suppressed FSE T2WI sequence and parallel 3D reconstruction. In individual cases where the internal opening is not clearly displayed, the diffusion-weighted imaging sequence can be tried. -
Key words:
- perianorectal /
- acute infection /
- MRI
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图 1 括约肌间隙脓肿
Figure 1. Abscess in the sphincter space. The oblique axis of the fat suppression T2WI FSE sequence shows patchy high signal (long arrow) in the sphincter space, and the internal opening (short arrow) is formed at 11 o'clock in the lithotomy position.
图 2 括约肌间隙脓肿
Figure 2. Abscess in the sphincter space. A: The fat suppression T2WI FSE sequence showed circular high signal intensity in the oblique axis of the anal area, with unclear display of local anatomical structure. B: The T2WI FSE sequence showed a circular high signal in the sphincter space at the oblique axis from 11 to 5 o'clock in the lithotomy position, with compression deformation of the anal canal (long arrow) and external sphincter (short arrow).
图 3 括约肌外型肛瘘并骶前脓肿
Figure 3. Extrasphincteric fistula with presacral abscess. A: The fat suppression T2WI FSE sequence in the oblique axis showed patchy high signal before sacrum. B: The MIP reconstruction of fat suppression T2WI FSE sequence in oblique coronal showed full view of irregular presacral abscess (long arrow), with a thin linear fistula (short arrow) communicating with the rectum.
图 4 括约肌外型肛瘘
Figure 4. Extralsphincteric fistula. A: The fat suppression T2WI FSE sequence in oblique axis showed a circular mixed signal on the outer side of the right external sphincter. B: The DWI (EPI sequence b=1000 s/mm2) showed a circular high signal on the outer side of the right external sphincter in an oblique axis, and a linear high signal fistula (long arrow) communicating with the anterior wall of the rectum (short arrow).
表 1 肛管直肠周围急性期感染MRI扫描参数
Table 1. MRI scan parameters for acute perianal infections
Sequence Scanning planes TR (ms) TE (ms) Thickness (mm) Matrix FOV NEX Fat saturated Scan time FSE T2WI Sag 2900 100 3 320×224 26×23 4 + 2 min 48 s FSE T2WI Oblique cor 2800 89 3 384×256 26×26 4 + 3 min 39 s FSE T1WI Oblique cor 400 8 3 384×224 26×26 4 4 min 5 s FSE T2WI Oblique tra 3250 120 3 384×224 28×28 4 + 3 min 35 s FSE T1WI Oblique tra 450 8 3 384×224 28×28 4 3 min 23 s FSE T2WI Oblique tra 3070 120 3 384×224 28×28 4 2 min 45 s DWI (b=1000 s/mm2) Oblique tra 5000 66 3 96×130 34×34 8 2 min 45 s 
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表 2 肛管直肠周围急性感染诊断序列或序列组合统计
Table 2. Statistics of diagnostic sequences or sequence combinations for acute perianal infections
Sequence Scan time n(%) Fat suppression FSE T2WI in oblique axis 3 min 35 s 40(53.3) Fat suppression FSE T2WI and non fat suppression FSE T2WI or T1WI sequence in oblique axis 6 min 20 s or 6 min 58 s 33(44.0) Fat suppression FSE T2WI in oblique axis and 3D reconstruction of the fat suppression T2WI FSE sequence in oblique coronal 6 min 20 s 1(1.3) Fat suppression FSE T2WI and DWI sequence in oblique axis 7 min 14 s 1(1.3) Total 75(100)
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