Department of Radiology, Numune Teaching and Research Hospital, Ege bagatur Bulvari Serinevler Yüreğir, Adana, Turkey.
Department of General Surgery, Numune Teaching and Research Hospital, Adana, Turkey.
Abdom Radiol (NY). 2016 Aug;41(8):1474-83. doi: 10.1007/s00261-016-0722-y.
The purpose of this study was to evaluate the diagnostic efficacies of CT fistulography and MRI, in the diagnostic work-up of perianal fistula patients.
All 41 patients who were included in the study (36 males and 5 females, with an average age of 41 years) underwent CT fistulography and MRI examinations prior to surgery. The fistula characteristics obtained from these examinations were compared with the surgical findings. The comparative results were evaluated by means of the Kappa analysis method.
CT fistulography predicted the correct perianal fistula classification in 30 (73.1%) of the 41 patients, whereas MRI correctly defined fistula classification in 38 (92.7%) of these patients (the K values were 0.621 and 0.896, respectively; with p < 0.001). CT fistulography depicted 29 secondary extensions in 16 patients, whereas MR imaging revealed 28 secondary extensions in 15 patients. A substantial agreement was found between surgical findings and two modalities (K value was 0.789 and 0.793 for CT fistulography and MRI, respectively, with a p value < 0.001). In terms of locations of internal openings, CT fistulography was able to detect the locations in 28 patients (68.2%), whereas MRI was more successful in this aspect, with a number of 35 patients (85.3%). Granulation tissues, inflammation and edema around the fistula, abscesses, and fistular wall fibrosis were also evaluated.
CT fistulography and MRI have different advantages in the diagnosis of perianal fistulas. A good command of knowledge concerning the issue may be a key factor in modality decision.
本研究旨在评估 CT 直肠造影和 MRI 在肛周瘘患者诊断中的诊断效能。
所有 41 例纳入研究的患者（男 36 例，女 5 例，平均年龄 41 岁）均在术前接受了 CT 直肠造影和 MRI 检查。比较这些检查获得的瘘管特征与手术结果。通过 Kappa 分析方法对比较结果进行评估。
CT 直肠造影术预测 41 例患者中 30 例（73.1%）正确的肛周瘘分类，而 MRI 正确定义了其中 38 例（92.7%）患者的瘘分类（K 值分别为 0.621 和 0.896，p<0.001）。CT 直肠造影术在 16 例患者中显示了 29 个继发扩展，而 MRI 成像在 15 例患者中显示了 28 个继发扩展。手术结果与两种影像学方法之间存在高度一致性（CT 直肠造影术和 MRI 的 K 值分别为 0.789 和 0.793，p 值均<0.001）。在内部开口位置方面，CT 直肠造影术能够检测到 28 例患者（68.2%）的位置，而 MRI 在这方面更为成功，能够检测到 35 例患者（85.3%）的位置。也评估了肉芽组织、瘘管周围的炎症和水肿、脓肿和瘘管壁纤维化。
CT 直肠造影和 MRI 在肛周瘘的诊断中有不同的优势。掌握该问题的相关知识可能是选择影像学方法的关键因素。
