Waniczek Dariusz, Adamczyk Tomasz, Arendt Jerzy, Kluczewska Ewa, Kozińska-Marek Ewa
Department and Clinic of General and Gastroenterological Surgery of Medical University of Silesia in Katowice, Bytom, Poland.
Pol J Radiol. 2011 Oct;76(4):40-4.
Accurate preoperative assessment of the perianal fistulous tract is the main purpose of the diagnostics and to a large extend determines surgery effectiveness. One of the useful diagnostic methods in perianal fistulas is magnetic resonance imaging. The authors presented experiences in the application of MRI fistulography for evaluation of cases of perianal fistulas difficult to diagnose and treat.
MATERIAL/METHODS: Own examination method was described; MRI fistulography findings were analyzed and compared with intraoperative conditions in 14 patients (11 men and 3 women) diagnosed in the years 2005- 2009. Eight patients had recurrent fistulas and 6 had primary fistulas. Imaging was performed with a GE SIGNA LX HS scanner with a 1.5-Tesla field strength and a dedicated surface coil placed at the level of hip joints. Contrast agent was a gadolinium-based solution.
Intraoperative findings were consistent with radiological descriptions of 13 MRI fistulographies. Only in one case, according to surgery findings, it was a transsphincteric fistula with an abscess in the ischioanal fossa, with an orifice in the posterior crypt; the radiologist described it as a transsphincteric, internal blind fistula.
Due to its accuracy in the assessment of the perianal fistulous tracts in soft tissues, MRI fistulography becomes a useful and recommended diagnostic method in this pathology. It shows the location of the fistula regarding the system of anal sphincters, and identifies the internal orifice and branching of the fistula. It enables precise planning of surgical treatment. Authors suggest that this diagnostic method should be improved and applied more commonly.
准确的术前肛管周围瘘管评估是诊断的主要目的，并且在很大程度上决定手术效果。磁共振成像（MRI）是肛管周围瘘管有用的诊断方法之一。作者介绍了应用MRI瘘管造影术评估难以诊断和治疗的肛管周围瘘管病例的经验。
材料/方法：描述了自身的检查方法；分析了2005年至2009年诊断的14例患者（11例男性和3例女性）的MRI瘘管造影结果，并与术中情况进行比较。8例患者有复发性瘘管，6例有原发性瘘管。成像使用GE SIGNA LX HS扫描仪，场强为1.5特斯拉，在髋关节水平放置专用表面线圈。造影剂为钆基溶液。
13例MRI瘘管造影的影像学描述与术中发现一致。仅在1例中，根据手术结果，为经括约肌瘘管，坐骨直肠窝有脓肿，开口于后隐窝；放射科医生将其描述为经括约肌内盲瘘。
由于MRI瘘管造影术在评估肛管周围软组织瘘管方面的准确性，它成为这种病理情况下一种有用且推荐的诊断方法。它显示了瘘管相对于肛门括约肌系统的位置，并确定了瘘管的内口和分支。它能够精确规划手术治疗。作者建议应改进并更普遍地应用这种诊断方法。
