目的：探讨3．0 T 磁共振（MRI）扩散加权成像（DWI）对肛瘘的诊断价值。方法：40例经手术和病理证实的肛瘘患者接受3．0 T MRI DWI 、T2加权成像抑脂（T2 WI FS）及 T1加权成像抑脂（T1 WI FS）增强序列检查，分析各自影像学特征，比较3组扫描序列显示肛瘘内口及瘘管的准确性。结果：40例患者经病理证实共有48个内口和63个瘘管；DWI 序列显示43个内口（89．6％），57个瘘管（90．5％）；T2 WI FS 序列显示37个内口（77．1％），51个瘘管（81．0％）；T1 WI FS 增强序列显示45个内口（93．8％），59个瘘管（93．7％）。 T2 WI FS 与 T1 WI FS 增强序列在显示内口及瘘管的准确性方面差异有统计学意义（P ＜0．05），而 T2 WI FS 联合 DWI 显示内口及瘘管的准确性与 T2 WI FS 联合 T1 WI FS 增强比较，差异无统计学意义。结论：加入MR DWI 序列使 MRI 平扫序列诊断肛瘘的准确性与增强序列相仿，DWI 序列与常规序列的合理结合可进一步提高检查适用性，可作为肛瘘 MRI 检查的常规诊断序列。%Objective :To evaluate diffusion-weighted imaging (DWI) sequence for detecting the perianal fistulas by comparing it with the conventional magnetic resonance imaging (MRI) sequences .Methods :MRI findings of 40 patients with the perianal fistula proved surgically and pathologically were retrospectively analyzed . The findings of the perianal fistulas on DWI , T2-weighed imaging with fat saturation (T2 WI FS ) and T1-weighed imaging with fat saturation (T1 WI FS ) contrasted-enhancement were recorded .The comparisons of DWI with T2 WI FS and T1 WI FS contrasted-enhancement for identifying the internal openings and fistulas were performed .Results :In the forty patients ,48 fistulas and 63 internal openings were found . Forty-three (89 .6% ) internal openings and 57 (90 .5% ) fistulas were found on DWI ;37 (77 .1% ) internal openings and 51 (81 .0% ) fistulas were found on T2 WI FS ;45 (93 .8% ) internal openings and 59 (93 .7% ) fistulas were found on T1 WI FS contrasted-enhancement .The comparison in accuracy shows that distinction between T2 WI FS and T1 WI FS contrasted enhancement was statistically significant ,but there has no statistically significant difference in diagnostic accuracy between T2 WI FS combined with DWI and T2 WI FS combined with T1 WI FS contrasted enhancement .Conclusions :The accuracy of plain scan including DWI for diagnosis of perianal fistula was similar with enhanced sequence .The reasonable combination of DWI and conventional sequence can further improve the applicability of the inspection ,which can be used as a routine diagnostic MRI examination sequence for perianal fistula .
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