| PART ONE Comparison of the display rate of anal fistula internal orifice,fistula(main fistula,branched fistula)by MRIObjective:Based on the intraoperative findings and the pathological diagnostic results,compare the display rate of the internal orifice and fistula(main fistula,branched fistula)by MRI.Data and methods:collect from Shanghai Jiading District Hospital of Traditional Chinese Medicine since November 2020 to July 2021 for anal fistula patients clinical,imaging and pathological data,cases included in the study have complete preoperative MRI data,operation records,postoperative pathology confirmed anal fistula(chronic inflammation wall tissue),MRI scan sequence includes T 1 weighted image(T1WI),Proton density-weighted imaging-Fat suppression(PDWI-FS),Diffusion-weighted image(DWI)and T1 weighted imaging-Fat suppression-Contrast(T1WI-FS-C).The image met the evaluation requirements,two doct ors(with experience in the diagnosis of anal fistula)read the film independently without informing the operation and pathological results,observe and evaluate the internal orifice(location and quantity)and the fistula(main fistula,branch fistula).If the evaluation results of the two readers are inconsistent,a senior doctor will do the analysis.Three doctors will discuss and make a conclusion and record it.Cases included in the study were divided into 2 groups(simple anal fist ula and Complexity anal fistula),using the McNemar test,analyse the display rate of the internal orifice and fistula(main fistula and branch fistula),and compared the display rate of the internal orifice and fistula(main fistula and branch fistula)between each sequence.Results:Among the 98 patients included in the study,36 were simple anal fistula and 62 were Complexity anal fistula.The results were as follows:1.Simple anal fistula group(36 cases):1).Internal orifice display rate of MRI sequence:22.22%(8/36)for T1WI,75.00%(27/36)for PDWI-FS,52.78%(19/36)for DWI,77.78%(28/36)for T1WI-FS-C;2).Fistula display rate of MRI sequence:44.44%(16/36)for T1WI,88.89%(32/36)for PDWI-FS,72.22%(26/36)for DWI,and 97.22%(35/36)for T1WI-FS-C;3).Comparison of the internal orifice display rate of anal fistula between the sequences of MRI:T1WI vs.DWI(P=0.007),T1WI vs.PDWI-FS(P<0.001),T1WI vs.T1WI-FS-C(P<0.001),DWI vs.PDWI-FS(P=0.008),DWI vs.T1WI-FS-C(P=0.004),PDWI-FS vs.T1 WI-FS-C(P=1.000);4).Comparison of the fistula display rate between sequences of MRI:T1WI vs.DWI(P=0.021),T1WI vs.PDWI-FS(P<0.001),T1WIvs.T1WI-FS-C(P<0.001),DWI vs.PDWI-FS(P=0.031),DWI vs.T1WI-FS-C(P=0.004),PDWI-FS vs.T 1 WI-FS-C(P=0.25)。2.Complexity anal fistula group(62 cases):A total of 111 anal fistula orifice,19 cases with 1 orifice,39 cases with 2 orifice,3 cases with 3 orifice,1 case with 5 orifice;104 main fistula,24 cases with 1 fistula,36 cases with 2 fistula,l case with 3 fistula,1 case with 5 fistula;25 branching fistulas,23 cases with 1 branching fistulas,1 case with 2 branching fistulas.1).Internal orifice display rate of MRI sequence:8.11%(9/111)for T1WI,79.28%(88/111)for PDWI-FS,45.05%(50/111)for DWI,and 87.39%(97/111))for T1 WI-FS-C;2).Main fistula display rate of MRI sequence:38.46%(40/104)for T1WI,81.73%(85/104)for PDWI-FS,65.38%(68/104)for DWI,and 92.31%(96/104)for T1WI-FS-C;3).Branching fistula display rate of MRI sequence:4.00%(1/25)for T1WI,64.00%(16/25)for PDWI-FS,16.00%(4/25)for DWI,and 80.00%(20/25)for T1WI-FS-C;4).Comparison of the internal orifice display rate of anal fistula between the sequences of MRI:T1WI vs.DWI(P<0.001),T1WI vs.PDWI-FS(P<0.001),T1WI vs.T1WI-FS-C(P<0.001),DWI vs.PDWI-FS(P<0.001),DWI vs.T1WI-FS-C(P<0.001),PDWI-FS vs.T1WI-FS-C(P=0.004);5).Comparison of the main fistula display rate of anal fistula between the sequences of MRI:T1WI vs.DWI(P<0.001),T1WI vs.PDWI-FS(P<0.001),T1WI vs.T1WI-FS-C(P<0.001),DWI vs.PDWI-FS(P<0.001),DWI vs.T1WI-FS-C(P<0.001),PDWI-FS vs.T1WI-FS-C(P=0.001);6).Comparison of the Branching fistula display rate of anal fistula between the sequences of MRI:T1WI vs.DWI(P=0.250),T1WI vs.PDWI-FS(P<0.001),T1WI vs.T1WI-FS-C(P<0.001),DWI vs.PDWI-FS(P<0.001),DWI vs.T1WI-FS-C(P<0.001),PDWI-FS vs.T1WI-FS-C(P=0.125)。Conclusion:Among the scan sequence of the MRI(T1WI、PDWI-FS、DWI、T1WI-FS-C),.T1WI-FS-C and PDWI-FS are important sequences to show the anal fistula internal orifice and fistula(main fistula,branch fistula),which should be included in the combination of MRI examination sequences of anal fistula.PART TWO Comparative analysis of the display rate of internal orifice and fistula(main fistula,branch fistula)and the diagnostic score results for internal orifice by MRI sequence and sequence combinationObjective:Based on the intraoperative findings and the pathological diagnostic results,compare the display rate of the internal orifice and fistula(main fistula,branched fistula)by MRI sequence and sequence combination;Comparative analysis of the diagnostic score results for internal orifice by MRI sequence and sequence combination,discuss the consistency of the diagnostic score results for internal orifice among different physicians,to screen the constituent sequence of the MRI sequence combination of anal fistula.Data and methods:collect from Shanghai Jiading District Hospital of Traditional Chinese Medicine since November 2020 to July 2021 for anal fistula patients clinical,imaging and pathological data,cases included in the study have complete preoperative MRI data,operation records,postoperative pathology confirmed anal fistula(chronic inflammation wall tissue),Based on the results of the first part of the study,The MRI sequences studied in this part include:PDWI-FS,DWI,and T1WI-FS-C,Sequence combinations include:PDWI-FS+DWI and PDWI-FS+DWI+T1WI-FS-C,All the sequence images met the evaluation requirements,two doctors(with experience in the diagnosis of anal fistula)read the film independently without informing the operation and pathological results,obser ve and evaluate the internal orifice(location and quantity)and the fistula(main fistula,branch fistula).If the evaluation results of the two readers are inconsistent,a senior doctor will do the analysis.Three doctors will discuss and make a conclusion and record it.Cases included in the study were divided into 2 groups(simple anal fistula and Complexity anal fistula),using the McNemar test,analyse the display rate of the internal orifice and fistula(main fistula and branch fistula),and compared the display rate of the internal orifice and fistula(main fistula and branch fistula)between each MRI sequence and sequence combination.By twodoctor independently,Diagnostic score for anal fistula internal orifice,The results of simple and complexity anal fistula were analyzed by the Wilcoxon signed rank test,and the consistency between the diagnosis of simple and complexity anal fistula was evaluated by the Kappa consistency test.Results:1.Simple anal fistula group(36 cases):1).Internal orifice display rate of MRI sequence combination:80.56%(29/36)for PDWI-FS+DWI,83.33%(30/36)for PDWI-FS+DWI+T1WI-FS-C;2).Fistula display rate of MRI sequence combination:94.44%(34/36)for PDWI-FS+DWI,100.00%(36/36)for PDWI-FS+DWI+T1WI-FS-C;3).Pairwise comparison of internal orifice display rate between MRI sequence and sequence combinations:DWI vs.PDWI-FS+DWI(P=0.002),DWI vs.PDWI-FS+DWI+T1WI-FS-C(P=0.001),PDWI-FS vs.PDWI-FS+DWI(P=0.500),PDWI-FS vs.PDWI-FS+DWI+T1WI-FS-C(P=0.250),T1WI-FS-C vs.PDWI-FS+DWI(P=1.000),T1WI-FS-C vs.PDWI-FS+DWI+T1WI-FS-C(P=0.500),PDWIFS+DWI vs.PDWI-FS+DWI+T1WI-FS-C(P=1.000);4).Pairwise comparison of fistula display rate between MRI sequence and sequence combinations:DWI vs.PDWI-FS+DWI(P=0.008),DWI vs.PDWI-FS+D WI+T1WI-FS-C(no P-value),PDWI-FS vs.PDWI-FS+DWI(P=0.500),PDWI-FS vs.PDWI-FS+DWI+T1WI-FS-C(no P-value).T1WI-FS-C vs.PDWI-FS+DWI(P=1.000),T1WI-FS-C vs.PDWI-FS+DWI+T1WI-FS-C(no P-value),PDWI-FS+DWI vs.PDWI-FS+DWI+T1WI-FS-C(no P-value).5).Results of the internal orifice diagnostic score of simple anal fistula:① Physician A:PDWI-FS 4Points,DWI 2.5Points,T1WI-FS-C 5Points,PDWI-FS+DWI 4Points,PDWI-FS+DWI+T1WI-FS-C 5Points;② Physician B:PDWI-FS 4Points,DWI 2.5Points,T1WI-FS-C 5Points,PDWI-FS+DWI 4Points,PDWI-FS+DWI+T1 WI-FS-C 5Points.6).Pairwise comparison of internal orifice diagnostic scores of anal fistula between MRI sequence and sequence combination:① Physician A:DWI vs.PDWI-FS+DWI(P<0.001),DWI vs.PDWI-FS+D WI+T1 WI-FS-C(P<0.001),PDWI-FS vs.PDWI-FS+DWI(P=0.705),PDWI-F S vs.PDWI-FS+DWI+T1WI-FS-C(P<0.001),T1WI-FS-C vs.PDWI-FS+DWI(P<0.001),T1 WI-FS-C vs.PDWI-FS+DWI+T1 WI-FS-C(P=0.083),PDWI-FS+DW I vs.PDWI-FS+DWI+T1WI-FS-C(P<0.001).②Physician B:DWI vs.PDWI-FS+DWI(P<0.001),DWI vs.PDWI-FS+DW I+T1 WI-FS-C(P<0.001),PDWI-FS vs.PDWI-FS+DWI(P=0.157),PDWI-FS vs.PDWI-FS+DWI+T1WI-FS-C(P<0.001),T1 WI-FS-C vs.PDWI-FS+DWI(P<0.001),T1 WI-FS-C vs.PDWI-FS+DWI+T1WI-FS-C(P=0.157),PDWI-FS+DWI vs.PDWI-FS+DWI+T1WI-FS-C(P<0.001).7).Consistent analysis of internal orifice diagnostic score results of simple anal fistula by two physicians:PDWI-FS(0.794),DWI(0.777),T1 WI-FS-C(0.876),PDWI-FS+DWI(0.809),PDWI-FS+DWI+T1WI-FS-C(0.938)。2.Complexity anal fistula group(62 cases):1).Internal orifice display rate of MRI sequence combination:81.08%(90/111)for PDWI-FS+DWI,89.19%(99/111)for PDWI-FS+DWI+T1WI-FS-C;2).Main fistula display rate of MRI sequence combination:84.62%(88/104)for PDWI-FS+DWI,92.31%(96/104)for PDWI-FS+DWI+T1WI-FS-C;3).Branching fistula display rate of MRI sequence combination:76.00%(19/25)for PDWI-FS+DWI,84.00%(21/25)for PDWI-FS+DWI+T1WI-FS-C.4).Pairwise comparison of internal orifice display rate between MRI sequence and sequence combinations:DWI vs.PDWI-FS+DWI(P<0.001),DWIvs.PDWI-FS+DWI+T1WI-FS-C(P<0.001),PDWI-FS vs.PDWI-FS+DWI(P=0.500),PDWI-FS vs.PDWI-FS+DWI+T1WI-FS-C(P=0.001),T1WI-FS-C vs.PDWI-FS+DWI(P=0.092),T1WI-FS-C vs.PDWI-FS+DWI+T1WI-FS-C(P=0.500),PDWIFS+DWIvs.PDWI-FS+DWI+T1WI-FS-C(P=0.090);5).Pairwise comparison of main fistula display rate between MRI sequence and sequence combination:DWI vs.PDWI-FS+DWI(P<0.001),DWI vs.PDWI-FS+DWI+T1WI-FS-C(P<0.001),PDWI-FS vs.PDWI-FS+DWI(P=0.250),PDW I-FS vs.PDWI-FS+DWI+T1WI-FS-C(P=0.001),T1WI-FS-C vs.PDWI-FS+DWI(P=0.008),T1WI-FS-C vs.PDWI-FS+DWI+T1WI-FS-C(P=1.000),PDWI-FS+DWI vs.PDWI-FS+DWI+T1WI-FS-C(P=0.083);6).Pairwise comparison of branching fistula display rate between MRI seque nce and sequence combination:DWI vs.PDWI-FS+DWI(P<0.001),DWI vs.PDW I-FS+DWI+T1WI-FS-C(P<0.001),PDWI-FS vs.PDWI-FS+DWI(P=0.250),P DWI-FS vs.PDWI-FS+DWI+T1WI-FS-C(P=0.063),T1WI-FS-C vs.PDWI-FS+DWI(P=1.000),T1WI-FS-C vs.PDWI-FS+DWI+T1WI-FS-C(P=1.000),PDWI-FS+DWI vs.PDWI-FS+DWI+T1WI-FS-C(P=0.480);7).Results of the internal orifice diagnostic score of Complexity anal fistula:①Physician A:PDWI-FS 2points,DWI 1point,T1WI-FS-C 3points,PDWI-FS+DWI 2points,PDWI-FS+DWI+T1WI-FS-C 3points;②Physician B:PDWI-FS 1.5points,DWI lpoint,T1WI-FS-C 3points,PDWI-FS+DWI 2points,PDWI-FS+DWI+T1WI-FS-C 3points.8).Pairwise comparison of internal orifice diagnostic scores of anal fistula between MRI sequence and sequence combination:① Physician A:DWI vs.PDWI-FS+DWI(P<0.001),DWI vs.PDWI-FS+D WI+T1 WI-FS-C(P<0.001),PDWI-FS vs.PDWI-FS+DWI(P<0.001),PDWI-F S vs.PDWI-FS+DWI+T1WI-FS-C(P<0.001),T1WI-FS-C vs.PDWI-FS+DWI(P<0.001),T1WI-FS-C vs.PDWI-FS+DWI+T1WI-FS-C(P=0.005),PDWI-FS+D WI vs.PDWI-FS+DWI+T1WI-FS-C(P<0.001);②Physician B:DWI vs.PDWI-FS+DWI(P<0.001),DWI vs.PDWI-FS+D WI+T1WI-FS-C(P<0.001),PDWI-FS vs.PDWI-FS+DWI(P=0.005),PDWI-F S vs.PDWI-FS+DWI+T1WI-FS-C(P<0.001),T1WI-FS-C vs.PDWI-FS+DWI(P<0.001),T1WI-FS-C vs.PDWI-FS+DWI+T1WI-FS-C(P=0.002),PDWI-FS+D WI vs.PDWI-FS+DWI+T1WI-FS-C(P<0.001);9).Consistent analysis of internal orifice diagnostic score results of Complex ity anal fistula by two physicians:PDWI-FS(0.944),DWI(0.939),T1WI-FSC(0.978),PDWI-FS+DWI(0.944),PDWI-FS+DWI+T1WI-FS-C(1.000).Conclusion:T1 WI-FS-C can be used as the key observation sequences,To improve the r eading efficiency of diagnostic physicians;When the T1WI-FS-C sequence is not available,we suggested to use the PDWI-FS+DWI sequence combinations,.PART THREE Predictive evaluation of T1WI-FS-C sequence and clinically relevant indicators for postoperative recurrence in patients with anal fistulaObjective:Through the comparative analysis of T1WI-FS-C and clinically relevant indicators between postoperative recurrence and no recurrence cases in patients with anal fistula,to explore the independent risk factors for recurrence after anal fistula surgery,provide an objective basis for the clinical prediction of post operative recurrence in patients with anal fistula.Data and methods:collect from Shanghai Jiading District Hospital of Traditional Chinese Medicine since November 2020 to July 2021 for anal fistula patients clinical,imaging and pathological data,cases included in the study have complete preoperative MRI data,operation records,postoperative pathology confirmed anal fistula(chronic inflammation wall tissue),.Postoperative patients were followed up and patients included in the study were grouped(recurrence vs non-recurrence group),Recording the relevant clinical observation measures(including gender,age)and T1WI-FS-C observed indicator(Including:perianal abscess,fistula type,internal orifice location,multi-level fistula),Data were statistically processed using the SPSS 26.0 software,using t-test for comparison between groups,count data are presented as(n),using x2 test,Multivariate Logistic regression analysis was used to explore the risk factors for postoperative recurrence in patients with anal fistula.P<0.05 was considered as statistically different.Results:1.There was no statistically significant difference in sex and age between the two groups(P>0.05);The recurrence rate of patients with perianalabs cess,high anal fistula,unclear internal orifice location,and multifaceted fistula is higher,There was statistically significant difference between the two groups(P<0.05);2 Combined perianal abscess,high fistula,multilevel fistula,and the unclear location of the internal orifice are independent risk factors affecting the recurrence of anal fistula.The risk of recurrence in perianal abscess was 29.060 times higher than in uncomplicated patients,the risk of recurrence in high fistula was 63.210 times that in low fistula.Conclusion:Perianal abscess,high fistula,multifaceted fistula,and unclear location of the internal orifice are all independent risk factors affecting the recurrence of anal fistula. |
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