Taylor Stuart A, Halligan Steve, Bartram Clive I
Intestinal Imaging Centre, Level 4V, St Mark's Hospital, Watford Rd, Northwick Park, Harrow, Middlesex HA1 3UJ, England.
Radiology. 2003 Mar;226(3):662-7. doi: 10.1148/radiol.2263011758. Epub 2003 Jan 15.
To describe magnetic resonance (MR) imaging features in patients with proved pilonidal sinus disease and to compare these features with those in a matched group of patients with proved fistula in ano to determine the accuracy with which MR imaging can be used to distinguish between the two diseases.
Seven patients with pilonidal sinus disease underwent MR imaging with a body coil. The site and morphology of sepsis were noted, with particular reference to natal cleft sepsis and deep-seated sepsis, including intersphincteric anal canal sepsis and any enteric communication. Comparison was made with 14 age- and sex-matched patients with fistula in ano. Categoric frequencies were compared to calculate differences between the groups and sensitivities, specificities, and predictive values.
All patients with pilonidal sinus had natal cleft sepsis, but five (71%) had sepsis at deep-seated sites more characteristic of fistula in ano. Eight patients with fistula in ano (57%) had natal cleft sepsis that was thought characteristic of pilonidal sinus. No patient with pilonidal sinus had intersphincteric sepsis or an enteric communication, in contrast to all patients with fistula in ano having both (P <.001). Natal cleft sepsis reached the subcutaneous tissues overlying the coccyx and sacrum in only one patient with fistula (7%), in contrast to six (86%) with pilonidal sinus (P <.001). MR imaging had a sensitivity of 86% (six of seven), specificity of 100% (14 of 14), positive predictive value of 100% (six of six), and negative predictive value of 93% (14 of 15) for diagnosis of pilonidal sinus disease.
MR imaging features of perianal and deep-seated sepsis, characteristic of fistula in ano, are also found in patients with pilonidal sinus, but the absence of intersphincteric sepsis or enteric opening allows reliable MR imaging distinction between the two.
描述确诊藏毛窦疾病患者的磁共振（MR）成像特征，并将这些特征与一组匹配的确诊肛瘘患者的特征进行比较，以确定MR成像用于区分这两种疾病的准确性。
7例藏毛窦疾病患者采用体线圈进行MR成像。记录脓毒症的部位和形态，特别提及臀裂脓毒症和深部脓毒症，包括肛管括约肌间脓毒症及任何与肠道的相通情况。与14例年龄和性别匹配的肛瘘患者进行比较。比较分类频率以计算组间差异以及敏感度、特异度和预测值。
所有藏毛窦患者均有臀裂脓毒症，但5例（71%）在深部部位有脓毒症，这些部位更具肛瘘特征。8例肛瘘患者（57%）有被认为是藏毛窦特征的臀裂脓毒症。与所有肛瘘患者均有肛管括约肌间脓毒症及与肠道相通情况相反，没有藏毛窦患者有肛管括约肌间脓毒症或与肠道相通情况（P<0.001）。仅1例肛瘘患者（7%）的臀裂脓毒症延伸至尾骨和骶骨上方的皮下组织，相比之下，6例（86%）藏毛窦患者有此情况（P<0.001）。MR成像诊断藏毛窦疾病的敏感度为86%（7例中的6例），特异度为100%（14例中的14例），阳性预测值为100%（6例中的6例），阴性预测值为93%（15例中的14例）。
肛周和深部脓毒症的MR成像特征在肛瘘患者中也有发现，这些特征是肛瘘的特点，但藏毛窦患者不存在肛管括约肌间脓毒症或肠道开口，这使得MR成像能够可靠地区分这两种疾病。
