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Abstract：
BACKGROUND: Perianal fistula is clinically diagnosed and commonly characterized using magnetic resonance imaging (MRI). Diffusion-weighted imaging (DWI) and T2-weighted imaging are emerging techniques that can obviate the need for contrast injection in cases where contrast administration is not feasible or contraindicated. The main objective of our study was to compare the efficacy of the combination of DWI and T2 STIR (short tau inversion recovery) imaging with contrast-enhanced MRI for the diagnosis and characterization of perianal fistula.
METHODS: Sixty-nine patients with clinical perianal fistula with at least one external opening were evaluated with DWI, T2 STIR, and contrast MRI. A comparative cross-sectional study was conducted in the Department of Radiodiagnosis and Imaging, All India Institute of Medical Sciences, Bhopal, India. The chi-square test was done to find the association between categorical variables. The Kappa test was done to estimate the agreement between two different tests in measuring the outcome. The validity of tests was measured using sensitivity, specificity, positive predictive value, negative predictive value, and accuracy.
RESULTS: The combination of DWI and T2 STIR is equivalent to contrast-enhanced MRI in the evaluation of primary and complicated perianal fistula. The combination of DWI and T2 STIR is superior to DWI alone in the classification and characterization of perianal fistula. However, DWI is superior to T2 STIR in differentiating perianal inflammation with abscess from perianal inflammation without abscess and can be used as an alternative to post-contrast fat-suppressed T1-WI in the detection of perianal abscesses and disease activity.
CONCLUSIONS: DWI can be used as an adjunct to T2 STIR, and the combination of DWI and T2 STIR can replace the post-contrast fat-suppressed T1 MRI sequence in the classification and characterization of perianal fistula.
METHODS: Sixty-nine patients with clinical perianal fistula with at least one external opening were evaluated with DWI, T2 STIR, and contrast MRI. A comparative cross-sectional study was conducted in the Department of Radiodiagnosis and Imaging, All India Institute of Medical Sciences, Bhopal, India. The chi-square test was done to find the association between categorical variables. The Kappa test was done to estimate the agreement between two different tests in measuring the outcome. The validity of tests was measured using sensitivity, specificity, positive predictive value, negative predictive value, and accuracy.
RESULTS: The combination of DWI and T2 STIR is equivalent to contrast-enhanced MRI in the evaluation of primary and complicated perianal fistula. The combination of DWI and T2 STIR is superior to DWI alone in the classification and characterization of perianal fistula. However, DWI is superior to T2 STIR in differentiating perianal inflammation with abscess from perianal inflammation without abscess and can be used as an alternative to post-contrast fat-suppressed T1-WI in the detection of perianal abscesses and disease activity.
CONCLUSIONS: DWI can be used as an adjunct to T2 STIR, and the combination of DWI and T2 STIR can replace the post-contrast fat-suppressed T1 MRI sequence in the classification and characterization of perianal fistula.
摘要：
背景：肛周瘘的临床诊断和通常使用磁共振成像（MRI）进行表征。扩散加权成像（DWI）和T2加权成像是新兴的技术，可以在造影剂给药不可行或禁忌的情况下消除造影剂注射的需要。我们研究的主要目的是比较DWI和T2STIR（短tau倒置恢复）成像与对比增强MRI联合诊断和表征肛周瘘的疗效。
方法：对69例至少有一个外开口的临床肛瘘患者进行DWI评估，T2STIR,和对比MRI。在放射诊断和成像系进行了一项比较横断面研究，全印度医学科学研究所，博帕尔,印度。进行卡方检验以找到分类变量之间的关联。进行Kappa检验以估计两种不同测试在测量结果时的一致性。测试的有效性是用灵敏度来衡量的，特异性，正预测值，负预测值，和准确性。
结果：DWI和T2STIR的组合在原发性和复杂性肛瘘的评估中相当于对比增强MRI。DWI和T2STIR的组合在肛瘘的分类和表征方面优于单独的DWI。然而,DWI在区分有脓肿的肛周炎症与无脓肿的肛周炎症方面优于T2STIR，并且可以用作对比后脂肪抑制的T1-WI的替代方法，用于检测肛周脓肿和疾病活动。
结论：DWI可以用作T2STIR的辅助手段，DWI和T2STIR的组合可以替代对比后脂肪抑制的T1MRI序列，用于肛瘘的分类和表征。
方法：对69例至少有一个外开口的临床肛瘘患者进行DWI评估，T2STIR,和对比MRI。在放射诊断和成像系进行了一项比较横断面研究，全印度医学科学研究所，博帕尔,印度。进行卡方检验以找到分类变量之间的关联。进行Kappa检验以估计两种不同测试在测量结果时的一致性。测试的有效性是用灵敏度来衡量的，特异性，正预测值，负预测值，和准确性。
结果：DWI和T2STIR的组合在原发性和复杂性肛瘘的评估中相当于对比增强MRI。DWI和T2STIR的组合在肛瘘的分类和表征方面优于单独的DWI。然而,DWI在区分有脓肿的肛周炎症与无脓肿的肛周炎症方面优于T2STIR，并且可以用作对比后脂肪抑制的T1-WI的替代方法，用于检测肛周脓肿和疾病活动。
结论：DWI可以用作T2STIR的辅助手段，DWI和T2STIR的组合可以替代对比后脂肪抑制的T1MRI序列，用于肛瘘的分类和表征。
