Yang Fubin, Sheng Mao, Wang Jian, Guo Wanliang, Wang Qi, Han Xiao
Department of Radiology, the Children's Hospital Affiliated to Soochow University, Suzhou 215003, China.
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Zhonghua Er Ke Za Zhi. 2014 Jan;52(1):41-5.
To investigate the clinical value of MRI examination in congenital anorectal malformation (CARM).
Forty-four cases with operatively proved anorectal malformation from May 2008 to May 2012 in the authors' hospital were reviewed. Of the 44 cases, 25 were males and 19 females, their age ranged from 1 day to 2 years. MRI was performed in all patients.
Of all 44 cases, 15 cases had high imperforate anus (34%), rectum blind end were above PC line, the distance of rectum blind end and anus nest was (29.12 ± 2.35) mm; 8 cases had median imperforate anus (18%), rectum blind ends were near PC line, the distance of rectum blind end and anus nest was (18.98 ± 2.21) mm; 21 cases had low imperforate anus (48%), rectum blind ends were below PC line, the distance of rectum blind end and anus nest was (7.54 ± 1.08) mm. Twenty-five cases with fistula in 44 cases were confirmed by rectal angiography and surgery, accounting for 57%. In 13 cases with fistula, the lesion could be clearly demonstrated on MRI, in the remaining 12 cases with fistula, the lesion could not be visualized clearly or no image development occurred on MRI. Of all 44 cases, 1 case had tethered cord with filum terminale lipoma, 1 case had tethered cord, 2 cases had syringomyelia, 1 case had right kidney agenesis, 1 case had hydrocele. In 44 cases of multi-planar MRI imaging could clearly show the perianal muscles developmental situation, 36 cases had perianal muscles dysplasia, amd showed levator ani muscle, puborectalis and anal sphincter asymmetry, muscle belly slim.
MRI examination has a high clinical value in CARM diagnosis, can help accurately judge the anal atresia type, display the presence and running of most of the fistula, and diagnose perianal muscle development and other systems malformations, finally provide a reliable diagnostic basis for surgical program and prognostic assessment.
探讨MRI检查在先天性肛门直肠畸形（CARM）中的临床价值。
回顾性分析2008年5月至2012年5月在作者所在医院手术证实为肛门直肠畸形的44例患者。44例中，男性25例，女性19例，年龄1天至2岁。所有患者均行MRI检查。
44例中，高位肛门闭锁15例（34%），直肠盲端在耻骨直肠肌（PC）线以上，直肠盲端与肛门窝距离为（29.12±2.35）mm；中位肛门闭锁8例（18%），直肠盲端靠近PC线，直肠盲端与肛门窝距离为（18.98±2.21）mm；低位肛门闭锁21例（48%），直肠盲端在PC线以下，直肠盲端与肛门窝距离为（7.54±1.08）mm。44例中有25例瘘管经直肠造影及手术证实，占57%。13例瘘管患者MRI能清晰显示病变，其余12例瘘管患者MRI未能清晰显示病变或无影像显影。44例中，1例合并终丝脂肪瘤性脊髓栓系，1例合并脊髓栓系，2例合并脊髓空洞症，1例合并右肾缺如，1例合并鞘膜积液。44例多平面MRI成像均能清晰显示肛周肌肉发育情况，36例肛周肌肉发育不良，表现为肛提肌、耻骨直肠肌及肛门括约肌不对称，肌腹纤细。
MRI检查在CARM诊断中具有较高临床价值，能帮助准确判断肛门闭锁类型，显示大部分瘘管的存在及走行，诊断肛周肌肉发育及其他系统畸形，最终为手术方案及预后评估提供可靠的诊断依据。
