Teymouri Alireza, Keshvari Amir, Ashjaei Ali, Ahmadi Tafti Seyed Mohsen, Salahshour Faeze, Khorasanizadeh Faezeh, Naseri Amirhosein
Department of Colorectal Surgery Imam Reza Hospital Aja University of Medical Sciences Tehran Iran.
Department of Surgery Colorectal Research Center, Imam Hospital Complex Tehran University of Medical Sciences Tehran Iran.
Health Sci Rep. 2023 Jun 22;6(6):e1354. doi: 10.1002/hsr2.1354. eCollection 2023 Jun.
Anal fistula (AF) with cryptoglandular origin tends to recur, and multiple risk factors are implicated. Recently, some magnetic resonance imaging (MRI) findings with predictive value for disease outcomes have been proposed. These intrinsic anatomic features include those of the AF and its surrounding structures. This study aims to clarify the prognostic role of MRI in AF.
We performed a systematic search of PubMed, Embase, and EBSCO databases. Two independent reviewers conducted the search and screened the articles. We selected studies that used MRI to assess AF and reported its relationship to disease outcome. We extracted data regarding the study design, type of intervention, outcome, MRI-measured items, and their significance.
Out of 1230 retrieved articles, 18 were eligible for final inclusion, and a total of 4026 patients were enrolled in the selected studies. For preoperative MRI, the significant items affecting the outcome were the length of the fistula, horseshoe type, presence of multiple tracts, supralevator extension, and apparent diffusion coefficient (ADC) value. Other studies investigated the healing process using postoperative MRI.
This review found that MRI can be useful in the management of AF, both preoperatively and postoperatively. Factors, such as fistula length, horseshoe type, presence of multiple tracts, supralevator extension, and ADC value were found to be significantly associated with treatment outcomes. The presence of the fistula tract and the development of new abscesses on postoperative MRI was found to hinder the healing process. Further studies are needed to confirm these findings.
源于腺源性的肛瘘（AF）易于复发，且涉及多种风险因素。最近，已提出一些对疾病预后具有预测价值的磁共振成像（MRI）结果。这些内在解剖特征包括肛瘘及其周围结构的特征。本研究旨在阐明MRI在肛瘘中的预后作用。
我们对PubMed、Embase和EBSCO数据库进行了系统检索。两名独立的评审员进行检索并筛选文章。我们选择了使用MRI评估肛瘘并报告其与疾病预后关系的研究。我们提取了有关研究设计、干预类型、结局、MRI测量项目及其意义的数据。
在检索到的1230篇文章中，18篇符合最终纳入标准，所选研究共纳入4026例患者。对于术前MRI，影响结局的重要项目包括瘘管长度、马蹄形、多通道存在、提肌上扩展和表观扩散系数（ADC）值。其他研究使用术后MRI研究愈合过程。
本综述发现，MRI在肛瘘的术前和术后管理中均可能有用。发现瘘管长度、马蹄形、多通道存在、提肌上扩展和ADC值等因素与治疗结局显著相关。发现术后MRI上瘘管的存在和新脓肿的形成会阻碍愈合过程。需要进一步研究来证实这些发现。
