Application of Three-Dimensional Magnetic Resonance Imaging in the Diagnosis of Perianal Abscess

Abstract

Perianal abscess is a common disease in anorectal surgery. If the diagnosis is not clear and the cure is thoroughly cleared, the recurrence and spread of anal fistula will cause life-long pain. Objective: To investigate the application of 3.0T MRI 3D CUBE T2WI lipid suppression sequence in the diagnosis of perianal abscess. Methods: Thirty-six patients with perianal abscess confirmed by operation were examined with 2D T2WI and 3D CUBE T2WI lipid suppression sequences before operation. Two imaging techniques were evaluated to show the types of perianal abscess, the number of abscesses, the number of internal orifices of abscess, and the number of fistula branches with anal fistula in abscess. Results: Among 36 cases of perianal abscess, there were 5 cases of anal subcutaneous abscess, 12 cases of ischiorectal space abscess (8 cases complicated with anal fistula), 6 cases of posterior anal space abscess, 5 cases of anal sphincter abscess (3 cases complicated with anal fistula), 2 cases of high intermuscular abscess, 2 cases of rectal submucosal abscess, 3 cases of complex abscess (3 cases complicated with anal fistula), 1 case of misdiagnosis, 2D T2WI lipid suppression sequence and 3D CUBE T2WI suppression. The accuracy of lipid sequence abscess typing was 80.6% (29/36) and 88.9% (32/36), respectively, with no significant difference (P > 0.05). Thirty-six patients were surgically diagnosed as having 32 internal orifices, 68.8% (22/32) and 93.8% (30/32) of 2D T2WI and 3D CUBE T2WI lipid-suppressing sequences, respectively, with significant difference (P < 0.05); among the 36 patients, 14 had perianal abscess complicated with anal fistula, and 21 fistulas were found during the operation, 21 cases were found fistula, 61.9% (13/21) of fistula branches were found by 2D T2WI lipid-suppressing sequence and 90.5% (19/21) of 3D CUBE T2WI lipid-suppressing sequence. The difference was statistically significant (P < 0.05). The number of perianal abscesses was identical between the two scanning techniques. Conclusion: 3D CUBE T2WI lipid suppression sequence is superior to 2D T2WI lipid suppression sequence in the classification of perianal abscess, the number of internal orifices of abscess and the number of fistula branches of abscess complicated with anal fistula. It can also determine the number of internal orifices of abscess complicated with anal fistula, the number of fistula branches, the shape of primary and branch fistula and the relationship among pelvic floor muscle tissues. It can provide more accurate images for preoperative and intraoperative clinical surgery.