不同临床类型骶尾部藏毛窦的MRI表现
合集下载
- 1、下载文档前请自行甄别文档内容的完整性，平台不提供额外的编辑、内容补充、找答案等附加服务。
- 2、"仅部分预览"的文档,不可在线预览部分如存在完整性等问题,可反馈申请退款(可完整预览的文档不适用该条件!)。
- 3、如文档侵犯您的权益，请联系客服反馈,我们会尽快为您处理(人工客服工作时间：9:00-18:30)。
刘超，陈娇，王中秋.不同临床类型骶尾部藏毛窦的MRI表现[J].
• 54 * 医疗卫生装备,2021,42(7)：54-57,72.
不同临床类型骶尾部藏毛窦的MRI表现
刘超，陈娇，王中秋*
(南京中医药大学附属医院放射科，南京210029)
［摘要］目的:探讨不同类型骶尾部藏毛窦的MRI表现，以便于临床针对性地选择不同的治疗方法。方法：回顾性分 析43例经病理证实的骶尾部藏毛窦的盆腔MRI图像，依据Tezel's的临床分型方法分为5型，观察各型藏毛窦的走 行方向、形状、边界、长径及不同序列MRI的信号特点等，并分析其临床及病理表现。结果：43例骶尾部藏毛窦均位 于骶尾部臀间裂皮肤及皮下脂肪层内，均未累及肌肉组织，均未与骶管及肛管相通，窦道向头侧走行较多；病理显示
The sacrococcygeal PS has fairly typical MRI features in different clinical
types. MRI can provide the information on the range and scope of PS and its relationship with the surrounding tissue, and thus
diameter, acute abscesses, round - or oval -shaped lesions with clear borders, no obvious sinus openings and MRI features
such as marked high signal on DWI; there were 18 cases (41.9%) of type 芋 sacrococcygeal PS with 1.8 to 8.1 cm long
poorly defined borders, massive edema in the surrounding soft tissue and similar MRI features like type 芋，which all were
characterized by the operation history.
diameter and tubular lesions, which had defined borders and slightly high signal on DWI at chronic stage while restricted
edema in the surrounding soft tissue and marked high signal on DWI at acute stage; there were 3 cases (7.0%) of type 郁
communication with the sacral or anal canal, and the sinus tracts traveled cephalad frequently; pathological examinations
showed hair in 22 cases and abscess formation in 16 cases. There were four cases (9.3%) of type I sacrococcygeal PS, with
0引言
的一种慢性窦道，其特征为内藏毛发，也可表现为
骶尾部藏毛窦是指骶尾部臀间裂处软组织内 骶尾部急性脓肿,破溃后形成慢性窦道，反复发作,
-医疗卫生装备*2021 年 7 月第 42 卷第 7 期 Chinese Medical Equipment Journal• Vol.42• No.7• July 2021
MRI manifestations of different clinical types of sacrococcygeal
pilonidal sinuses
LIU Chao, CHEN Jiao, WANG Zhong-qiu* (Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China) Abstract O时ective To explore the MRI manifestations of different types of sacrococcygeal pilonidal sinuses (PS) in order to facilitate their clinical treatment, ^^^lods The MRI images of 43 patients with pathologically confirmed sacrococcygeal PS were analyzed retrospectively, and divided into 5 types according to Tezel classification, which were observed in terms of the
43例患者均行仰卧位平扫检查。仪器采用3.0T MR（Magnetom Trio Siemens,德国）,使用 8 通道体部 相控阵线圈，扫描参数:层厚4 mm,层间距1mm,矩 阵 256x256,视野（field of view, FOV ）350 mmx 350 mm。 扫描序列:轴位T1WI序列［重复时间（repetition time, TR）630 ms,回波时间（echo time,TE）10 ms］、轴位 T2WI-FS 序列（TR 6 500 ms ,TE 70 ms）、矢状位 T2WI-FS 序列（TR 4 300 ms,TE 70 ms）、轴位DWI 序 列（TR 2 900 ms、TE 80ms、b 值为 800 s/mm2）。 1.3临床分型
2 结果 2.1临床表现
骶尾部藏毛窦I型4例（93%）,域型8例（18.6%）, 皿型18例（41.9%）,郁型3例（7.0%）, V型10例 （23.3%）。男女比例6： 1, 17岁以下有7例，占16.3%, 均为男性;18~25岁28例，占65.1% ； 26~55岁8例， 占18•6%o高年龄患者中，V型骶尾部藏毛窦有6例， 且平均病程长。 2.2 MRI表现
is of significance for guiding clinical operation planning. ［Chinese Medical Equipment Journal,2021 ,42(7) ：54-57,72］
Key words sacrococcygeal pilonidal sinus; MRI; clinical typing; anal fistula; perianal abscess
1.3 to 4.0 cm long diameter, chronic inflammatory manifestations, lamellar lesions with poorly defined borders as well as MRI
features such as isosignal on DWI; there were eight cases (18.6%) of type 域 sacrococcygeal PS, with 2.娇，王中秋.不同临床类型骶尾部藏毛窦的MRI表现［J］.
医疗卫生装备,2021,42（7）：54-57,72.
• 55 •
很难自愈［1］,有时会被误诊为肛痿或局部感染,需要进 行鉴别诊断［2］o MRI可清晰显示其病灶范围、深度及 与周围肌肉、骶管及肛管的关系［3］,与骶尾部其他疾 病的鉴别诊断相比更容易，故目前术前MRI检查使 用得越来越多。临床上将藏毛窦分为5型，每种MRI 表现不同，治疗方法亦不同［3］o MRI可提供疾病分 型,帮助选择不同的手术方案。本文回顾性分析43 例病理证实的骶尾部藏毛窦的盆腔MRI图像，总结 每种类型藏毛窦的影像特征，以提高诊断水平。
22例见毛发,16例见脓肿形成。I型4例(9.3% ),长径1.3~4.0 cm,慢性炎症表现，病灶呈片状,边界不清,DWI呈等 信号为典型表现；域型8例(18.6%),长径2.8~6.7 cm,急性脓肿，呈圆形及椭圆形，边界较清，未见明显窦道口、DWI 呈明显高信号为典型表现；芋型18例(41.9%),长径1.8-8.1c m,呈管状，慢性期边界较清，DWI呈稍高信号，急性期 DWI呈明显高信号，周围软组织可见局限性水肿；郁型3例(7.0%),长径2.5-12 cm,MRI表现与芋型相仿，窦道口开 口位置可与芋型相鉴别；V型10例(23.3%),长径2.4~6.7 cm,边界不清，周围组织常有大片水肿，病灶信号特点与皿 型相仿，有手术病史为其特点。结论：不同类型骶尾部藏毛窦MRI表现各有特点，MRI可提供病灶范围、深度、与周围 组织关系等信息，能够为临床选择不同的手术方案提供指导。 ［关键词］骶尾部藏毛窦;磁共振成像；临床分型；肛痿;肛周脓肿 ［中国图书资料分类号］R318；R445.2 ［文献标志码］A ［文章编号］1003-8868(2021)07-0054-05 DOI：10.19745/j.1003-8868.2021144
sacrococcygeal PS with similar MRI features like type 芋,which could be differentiated from type 芋 sacrococcygeal PS by
the site of the sinus opening; there were 10 cases (23.3%) of type V sacrococcygeal PS, with 2.4 to 6.7 cm long diameter,
Tezel［4］将不同临床表现的骶尾部藏毛窦分为5 型：I型,无症状的结节,无脓肿或流脓病史；域型， 急性藏毛脓肿，有明显疼痛和肿胀,张力较大，无窦 道口 ；芋、郁型，有窦道口的结节，有脓肿或流脓病 史,以尾骨尖端为界，窦道口位于尾骨尖端上方的为 芋型，位于尾骨尖端下方与肛门之间的为郁型;V 型， 手术后复发的藏毛窦。
1资料与方法 1.1 一般资料
回顾性分析2014年1月至2020年8月在我院 经手术病理证实的43例骶尾部藏毛窦患者的临床 资料及术前盆腔MRI平扫图像。其中，男37例、女6 例，年龄13-55岁，平均年龄为23岁。临床表现主要 为骶尾部疼痛不适，局部肿胀、硬结形成、破溃，反复 排出脓性分泌物;10例有藏毛窦外科手术病史，术 后再次出现硬结、破溃及流脓。 1.2检查方法
1.4观察指标 由2位MRI诊断医师在影像工作站阅片，确定有
无窦道口、窦道口的开口位置、窦道走行的方向、有无 合并感染、与椎管及肛管之间的关系，分析5种类型藏 毛窦的数量、形状、边界、长径、不同序列的信号特点。
作者简介:刘 超（1989—）,女，硕士，主治医师,主要从 事医学影像诊断方面的研究工作,E-mail:297497214@ 。 通信作者：王中秋，E-mail：717558604@
sacrococcygeal PS' direction of travel, shape, boundary and long diameter as well as the features of different sequences of
MRI signals. The clinical and pathological manifestations were analyzed.
All the 43 patients had the sacrococcygeal
PS located within the skin and subcutaneous fat layer of sacrococcygeal hiatus, with no involvement of muscle tissue and no
• 54 * 医疗卫生装备,2021,42(7)：54-57,72.
不同临床类型骶尾部藏毛窦的MRI表现
刘超，陈娇，王中秋*
(南京中医药大学附属医院放射科，南京210029)
［摘要］目的:探讨不同类型骶尾部藏毛窦的MRI表现，以便于临床针对性地选择不同的治疗方法。方法：回顾性分 析43例经病理证实的骶尾部藏毛窦的盆腔MRI图像，依据Tezel's的临床分型方法分为5型，观察各型藏毛窦的走 行方向、形状、边界、长径及不同序列MRI的信号特点等，并分析其临床及病理表现。结果：43例骶尾部藏毛窦均位 于骶尾部臀间裂皮肤及皮下脂肪层内，均未累及肌肉组织，均未与骶管及肛管相通，窦道向头侧走行较多；病理显示
The sacrococcygeal PS has fairly typical MRI features in different clinical
types. MRI can provide the information on the range and scope of PS and its relationship with the surrounding tissue, and thus
diameter, acute abscesses, round - or oval -shaped lesions with clear borders, no obvious sinus openings and MRI features
such as marked high signal on DWI; there were 18 cases (41.9%) of type 芋 sacrococcygeal PS with 1.8 to 8.1 cm long
poorly defined borders, massive edema in the surrounding soft tissue and similar MRI features like type 芋，which all were
characterized by the operation history.
diameter and tubular lesions, which had defined borders and slightly high signal on DWI at chronic stage while restricted
edema in the surrounding soft tissue and marked high signal on DWI at acute stage; there were 3 cases (7.0%) of type 郁
communication with the sacral or anal canal, and the sinus tracts traveled cephalad frequently; pathological examinations
showed hair in 22 cases and abscess formation in 16 cases. There were four cases (9.3%) of type I sacrococcygeal PS, with
0引言
的一种慢性窦道，其特征为内藏毛发，也可表现为
骶尾部藏毛窦是指骶尾部臀间裂处软组织内 骶尾部急性脓肿,破溃后形成慢性窦道，反复发作,
-医疗卫生装备*2021 年 7 月第 42 卷第 7 期 Chinese Medical Equipment Journal• Vol.42• No.7• July 2021
MRI manifestations of different clinical types of sacrococcygeal
pilonidal sinuses
LIU Chao, CHEN Jiao, WANG Zhong-qiu* (Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China) Abstract O时ective To explore the MRI manifestations of different types of sacrococcygeal pilonidal sinuses (PS) in order to facilitate their clinical treatment, ^^^lods The MRI images of 43 patients with pathologically confirmed sacrococcygeal PS were analyzed retrospectively, and divided into 5 types according to Tezel classification, which were observed in terms of the
43例患者均行仰卧位平扫检查。仪器采用3.0T MR（Magnetom Trio Siemens,德国）,使用 8 通道体部 相控阵线圈，扫描参数:层厚4 mm,层间距1mm,矩 阵 256x256,视野（field of view, FOV ）350 mmx 350 mm。 扫描序列:轴位T1WI序列［重复时间（repetition time, TR）630 ms,回波时间（echo time,TE）10 ms］、轴位 T2WI-FS 序列（TR 6 500 ms ,TE 70 ms）、矢状位 T2WI-FS 序列（TR 4 300 ms,TE 70 ms）、轴位DWI 序 列（TR 2 900 ms、TE 80ms、b 值为 800 s/mm2）。 1.3临床分型
2 结果 2.1临床表现
骶尾部藏毛窦I型4例（93%）,域型8例（18.6%）, 皿型18例（41.9%）,郁型3例（7.0%）, V型10例 （23.3%）。男女比例6： 1, 17岁以下有7例，占16.3%, 均为男性;18~25岁28例，占65.1% ； 26~55岁8例， 占18•6%o高年龄患者中，V型骶尾部藏毛窦有6例， 且平均病程长。 2.2 MRI表现
is of significance for guiding clinical operation planning. ［Chinese Medical Equipment Journal,2021 ,42(7) ：54-57,72］
Key words sacrococcygeal pilonidal sinus; MRI; clinical typing; anal fistula; perianal abscess
1.3 to 4.0 cm long diameter, chronic inflammatory manifestations, lamellar lesions with poorly defined borders as well as MRI
features such as isosignal on DWI; there were eight cases (18.6%) of type 域 sacrococcygeal PS, with 2.娇，王中秋.不同临床类型骶尾部藏毛窦的MRI表现［J］.
医疗卫生装备,2021,42（7）：54-57,72.
• 55 •
很难自愈［1］,有时会被误诊为肛痿或局部感染,需要进 行鉴别诊断［2］o MRI可清晰显示其病灶范围、深度及 与周围肌肉、骶管及肛管的关系［3］,与骶尾部其他疾 病的鉴别诊断相比更容易，故目前术前MRI检查使 用得越来越多。临床上将藏毛窦分为5型，每种MRI 表现不同，治疗方法亦不同［3］o MRI可提供疾病分 型,帮助选择不同的手术方案。本文回顾性分析43 例病理证实的骶尾部藏毛窦的盆腔MRI图像，总结 每种类型藏毛窦的影像特征，以提高诊断水平。
22例见毛发,16例见脓肿形成。I型4例(9.3% ),长径1.3~4.0 cm,慢性炎症表现，病灶呈片状,边界不清,DWI呈等 信号为典型表现；域型8例(18.6%),长径2.8~6.7 cm,急性脓肿，呈圆形及椭圆形，边界较清，未见明显窦道口、DWI 呈明显高信号为典型表现；芋型18例(41.9%),长径1.8-8.1c m,呈管状，慢性期边界较清，DWI呈稍高信号，急性期 DWI呈明显高信号，周围软组织可见局限性水肿；郁型3例(7.0%),长径2.5-12 cm,MRI表现与芋型相仿，窦道口开 口位置可与芋型相鉴别；V型10例(23.3%),长径2.4~6.7 cm,边界不清，周围组织常有大片水肿，病灶信号特点与皿 型相仿，有手术病史为其特点。结论：不同类型骶尾部藏毛窦MRI表现各有特点，MRI可提供病灶范围、深度、与周围 组织关系等信息，能够为临床选择不同的手术方案提供指导。 ［关键词］骶尾部藏毛窦;磁共振成像；临床分型；肛痿;肛周脓肿 ［中国图书资料分类号］R318；R445.2 ［文献标志码］A ［文章编号］1003-8868(2021)07-0054-05 DOI：10.19745/j.1003-8868.2021144
sacrococcygeal PS with similar MRI features like type 芋,which could be differentiated from type 芋 sacrococcygeal PS by
the site of the sinus opening; there were 10 cases (23.3%) of type V sacrococcygeal PS, with 2.4 to 6.7 cm long diameter,
Tezel［4］将不同临床表现的骶尾部藏毛窦分为5 型：I型,无症状的结节,无脓肿或流脓病史；域型， 急性藏毛脓肿，有明显疼痛和肿胀,张力较大，无窦 道口 ；芋、郁型，有窦道口的结节，有脓肿或流脓病 史,以尾骨尖端为界，窦道口位于尾骨尖端上方的为 芋型，位于尾骨尖端下方与肛门之间的为郁型;V 型， 手术后复发的藏毛窦。
1资料与方法 1.1 一般资料
回顾性分析2014年1月至2020年8月在我院 经手术病理证实的43例骶尾部藏毛窦患者的临床 资料及术前盆腔MRI平扫图像。其中，男37例、女6 例，年龄13-55岁，平均年龄为23岁。临床表现主要 为骶尾部疼痛不适，局部肿胀、硬结形成、破溃，反复 排出脓性分泌物;10例有藏毛窦外科手术病史，术 后再次出现硬结、破溃及流脓。 1.2检查方法
1.4观察指标 由2位MRI诊断医师在影像工作站阅片，确定有
无窦道口、窦道口的开口位置、窦道走行的方向、有无 合并感染、与椎管及肛管之间的关系，分析5种类型藏 毛窦的数量、形状、边界、长径、不同序列的信号特点。
作者简介:刘 超（1989—）,女，硕士，主治医师,主要从 事医学影像诊断方面的研究工作,E-mail:297497214@ 。 通信作者：王中秋，E-mail：717558604@
sacrococcygeal PS' direction of travel, shape, boundary and long diameter as well as the features of different sequences of
MRI signals. The clinical and pathological manifestations were analyzed.
All the 43 patients had the sacrococcygeal
PS located within the skin and subcutaneous fat layer of sacrococcygeal hiatus, with no involvement of muscle tissue and no