DWI-MRI在评价复杂性肛瘘活动性中的应用价值

发布时间：2018-06-24 11:23

本文选题：DWI-MRI + 肛瘘　；参考：《临床放射学杂志》2017年12期

【摘要】：目的探讨3.0 T磁共振(MRI)扩散加权成像(DWI)序列及其定量参数表观扩散系数(ADC)值在手术前后准确评价肛瘘活动性,以提高手术成功率同时降低术后复发率中的应用价值。方法回顾性分析49例经手术证实的复杂性肛瘘患者的临床资料,分析患者常规MRI及DWI序列图像特征,通过ADC图测量病灶ADC值,根据临床评价肛周疾病活动性指数(PDAI)将患者分为活动期组(19例)与缓解期组(30例),利用两独立样本t检验将两组的ADC均值进行比较,并绘制受试者工作特征曲线(ROC);同时将ADC评价活动性结果与PDAI指数进行相关性分析。结果测得ADC均值,缓解期组为(1.252±0.170)×10~(-3)mm~2/s,活动期组为(0.925±0.148)×10~(-3)mm~2/s,活动期瘘管的ADC均值低于缓解期(P0.001)。ROC曲线分析显示ADC值评价肛瘘病变活动性的曲线下面积(AUC)为0.94;取曲线中Youden指数最高时的截断ADC值1.101×10~(-3)mm~2/s为鉴别阈值,诊断敏感度为80%,特异度为94.7%(P0.001)。相关性分析,病灶ADC值与PDAI值呈负相关(r=-0.89,P0.001)。结论 DWI-MRI序列及其定量参数ADC值可较准确地判断病变活动性,应作为手术前后MRI检查肛瘘的常规序列加以开展,有助于帮助临床医生术前制定正确治疗方案以提高手术成功率,更适合于术后长期随访复查中应用。
[Abstract]:Objective to evaluate the value of 3.0T magnetic resonance (MRI) diffusion weighted imaging (DWI) and its quantitative parameter diffusion coefficient (ADC) in the accurate evaluation of anal fistula activity before and after operation in order to improve the success rate of operation and reduce the recurrence rate. Methods the clinical data of 49 patients with complicated anal fistula proved by operation were retrospectively analyzed. The features of conventional MRI and DWI sequences were analyzed. ADC values were measured by ADC map. According to the clinical evaluation of perianal disease activity index (PDAI), patients were divided into active group (19 cases) and remission group (30 cases). The operating characteristic curve (ROC) was drawn and the correlation between ADC evaluation activity and PDAI index was analyzed. Results the ADC mean value was measured. The mean value of ADCs in active fistula was (1.252 卤0.170) 脳 10 ~ (-3) mm ~ (-3) / s and (0.925 卤0.148) 脳 10 ~ (-3) mm ~ (-2) / s respectively. The mean value of ADCs in active fistula was lower than that in remission (P0.001) .ROC curve analysis showed that the area under curve (AUC) for evaluating the activity of anal fistula was 0.94.The truncated ADC value (1.101 脳 10 ~ (-3) of the highest Youden index was taken as the differential threshold. The diagnostic sensitivity was 80 and the specificity was 94.7% (P0.001). Correlation analysis showed that there was a negative correlation between ADC value and PDAI value (r-0. 89 卤P 0. 001). Conclusion DWI-MRI sequence and ADC value of quantitative parameters can accurately judge the activity of the lesion, which should be used as a routine sequence of MRI examination of anal fistula before and after operation, which is helpful to help clinicians to make correct treatment plan before operation to improve the success rate of operation. It is more suitable for long-term follow-up after operation.
【作者单位】：江苏省肿瘤医院放射科;江苏省中医院放射科;
【分类号】：R445.2;R657.16

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