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《中华消化外科杂志》2018年9月第17卷第9期论著·影像集锦

会阴部残留窦道MRI检查影像学特征

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引用本文:
乔立超,周寄文,章俊彪,等.会阴部残留窦道MRI检查影像学特征[J].中华消化外科杂志,2018,17(9):959-963.DOI:10.3760/cma.j.issn.1673-9752.2018.09.016.
【摘要】

目的:总结会阴部残留窦道(PPS)的MRI检查影像学特征。
方法:采用回顾性描述性研究方法。收集2010年7月至2017年1月南京中医药大学附属医院收治的7例PPS患者的临床资料。患者均为直肠癌经腹会阴联合切除术后。患者行MRI检查横轴位、矢状位和冠状位扫描,由两名副主任医师以上级别医师共同阅片,若诊断意见不统一,则协商后统一结果。观察指标:(1)MRI检查影像学特征。(2)治疗和随访情况。患者完成MRI检查后,根据MRI检查表现行窦道切除术,术后行常规病理学检查。采用电话方式进行随访,了解患者窦道复发和再次手术情况。随访时间截至2017年4月。
结果:(1)MRI检查影像学特征。①病灶位置:7例患者PPS病灶均位于骶前部位,头侧端最高达第三骶椎平面,向下延伸至会阴部。②形态及信号:7例患者窦道表现为不规则片状或管状异常信号;纤维化窦道壁T1加权成像(T1WI)和T2加权成像(T2WI)均呈低信号;窦道内容物T1WI为低信号,T2WI及T2加权成像-脂肪抑制(T2WI-FS)为高信号;7例患者中2例PPS信号均匀,5例信号混杂。③分支及囊腔:1例患者窦道在尾骨尖处出现分支,延伸至骶尾椎后方。4例患者窦道顶端膨大形成囊腔。④感染征象:3例患者窦道周围脂肪间隙模糊、渗出,与盆腔器官分界不清晰,部分粘连;1例患者伴见盆底肌肉增厚肿胀,T2WI-FS为高信号;2例患者见窦道后方片状积液,T2WI-FS为高信号,提示骶前组织水肿。⑤强化特征:1例患者行MRI增强扫描示窦道轻度均匀强化。(2)治疗和随访情况:7例患者均行窦道切除术,其中2例因位置较高无法全部切除,头侧部分窦道予以充分搔刮;5例顺利施行手术。患者术后常规抗感染治疗。创面愈合时间为14~78 d,平均愈合时间为42 d。术后病理学检查均可见不同程度的炎细胞浸润。7例患者均获得术后随访,随访时间为2~74个月,平均随访时间为40个月。7例患者中,6例愈合,1例3个月后窦道复发,暂未治疗。7例患者均未再次行清创术或皮瓣移植术。
结论:PPS的MRI检查影像学特征为骶前部位片状或管状异常信号,T1WI为低信号,T2WI及T2WI-FS为高信号,增强扫描窦道呈轻度均匀强化。

【Abstract】

Objective:To summarize the magnetic resonance imaging (MRI) features of the persistent perineal sinus (PPS).
Methods:The retrospective and descriptive study was conducted. The clinical data of 7 patients with PPS who were admitted to the Nanjing University of Traditional Chinese Medicine between July 2010 and January 2017 were collected. Patients received horizontal, anteroposterior axes and coronal scanning of MRI after abdominoperineal resection (APR) of rectal cancer. Two physicians read collectively films and then achieved consistent results if there was a disputed result. Observation indicators: (1) MRI features; (2) treatment and follow-up situations. Patients underwent resection of PPS according to results of MRI examination, and then regular pathological examination. Follow-up using telephone interview was performed to detect sinus recurrence and reoperation up to April 2017.
Results:(1) MRI features: ① Lesion location: lesions of PPS in 7 patients were located at the presacral areas, top side was up to the third sacral plane, and lower side extended down to the pubic area. ② Morphology and signal: sinus tract of 7 patients showed irregular flaky and tubular abnormal signals; fibrotic sinus tract wall showed low signals in T1 weighted imaging (T1WI) and T2WI; contents of sinus tract in 7 patients showed low signal in T1WI and high signals in T2WI and T2WI-fat suppression (T2WI-FS).Of 7 patients, uniform signal and mixed signal were respectively detected in 2 and 5 patients. ③ Branches and cystic spaces: 1 patient had a branch at the tip of the coccyx, extending to the rear of the sacral vertebra. The top of sinus tract in 4 patients enlarged to form a cavity. ④ Signs of infection: signs of infection in 3 patients included blurred and exuded fat gaps around the sinus tract, unclear and partially adhesion with pelvic organ; the pelvic floor muscles in 1 patient were thickened and swollen, with a high signal in T2WI-FS; flaky fluid shadows in 2 patients were seen in the posterior sinus, with a high signal in T2WI-FS, showing a tissue edema of anterior sacrum. ⑤ Enhancement features: result of MRI examination of 1 patient showed mild and heterogeneous enhancement of sinus. (2) Treatment and follow-up situations: among 7 patients undergoing sinus resection, 2 received curettage of superior sinus due to high location, and 5 received successfully operation. All patients underwent postoperatively regular antibiotic therapy. The healing time was 14-78 days, with an average time of 42 days. The postoperative pathological examination showed different degrees of inflammatory cell infiltration. Seven patients were followed up for 2-74 months, with an average time of 40 months. Of 7 patients, sinus in 6 patients was healed, 1 had recurrence of sinus and didn′t receive therapy. Seven patients didn′t undergo debridement or transposition of skin flap again.
Conclusion:The MRI imaging features of PPS includes flaky and tubular abnormal signal in the the anterior sacrum, low signal in T1WI, high signals in T2WI and T2WI-FS, and the enhanced scanning of sinus duct shows mild and heterogeneous enhancement.

DOI:10.3760/cma.j.issn.1673-9752.2018.09.016
基金项目:江苏高校优势学科建设工程资助项目(035062002003);江苏省“十二五”中医药重点学科(js1301)
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