Department of Radiology, University Hospital Rotterdam, Rotterdam, The Netherlands.
AJR Am J Roentgenol. 2013 May;200(5):1034-41. doi: 10.2214/AJR.12.8813.
The purpose of this study was to assess the diagnostic value of anorectal MRI in the care of patients with chronic anal and perianal pain but without findings of abnormalities in the clinical workup.
Patients referred from a tertiary department of colorectal surgery to the MRI unit with clinically occult chronic anal and perianal pain were included. MRI of the anorectum was performed with an endoanal or pelvic phased-array coil. The images from all examinations were read by two radiologists. MRI findings were correlated with clinical follow-up data.
The study group (103 patients) was stratified into patients with no history of anorectal disease (n = 60) and those who had a history of surgery for anorectal disease (n = 43). MRI findings suggested the final diagnoses in 40 patients (39%). These diagnoses were 28 cases of suppurative lesions (27%), 11 cases of painful scarring of the anus (11%), and one case of metastasis to the sacrum (1%). Suppurative lesions were surgically proved with marked relief of pain after surgery. In the other patients the final diagnoses were 37 cases of levator ani syndrome (36%) and 26 cases of unspecified functional anorectal pain (25%). No MRI abnormalities were found in 33 of the patients with levator ani syndrome and 26 of the patients with unspecified anorectal pain. The two readers had very good agreement (κ = 0.92). The patients with a history of anorectal disease had significantly more MRI findings of abnormalities (60%) than did patients without a history of anorectal disease (23%). The positive predictive value of MRI was 91%, and the negative predictive value was 100%.
In 39% of patients, MRI showed abnormalities that were clinically confirmed as the final diagnosis. Surgical treatment will especially benefit patients with suppurative lesions, resulting in relief of pain.
本研究旨在评估直肠肛门 MRI 在慢性肛门和肛周疼痛但临床检查无异常的患者中的诊断价值。
本研究纳入了从一家肛肠外科三级科室转诊至 MRI 科室的慢性隐匿性肛门和肛周疼痛患者。采用腔内或盆腔相控阵线圈进行直肠肛门 MRI 检查。两名放射科医生阅读所有检查的图像。将 MRI 结果与临床随访数据进行相关分析。
研究组（103 例患者）分为无肛肠疾病史（n=60 例）和有肛肠疾病手术史（n=43 例）两组。MRI 结果提示 40 例（39%）患者的最终诊断。这些诊断包括 28 例化脓性病变（27%）、11 例肛门疼痛性瘢痕（11%）和 1 例骶骨转移（1%）。化脓性病变经手术证实，术后疼痛明显缓解。其余患者中 37 例为肛提肌综合征（36%），26 例为未明确的功能性肛门直肠痛（25%）。33 例肛提肌综合征患者和 26 例未明确肛门直肠痛患者中未见 MRI 异常。两位阅片者的一致性非常好（κ=0.92）。有肛肠疾病史的患者 MRI 异常的发现率（60%）显著高于无肛肠疾病史的患者（23%）。MRI 的阳性预测值为 91%，阴性预测值为 100%。
MRI 显示的异常在 39%的患者中被临床确认为最终诊断。手术治疗尤其有利于化脓性病变患者，可缓解疼痛。
