目的: 探讨磁共振成像(magnetic resonance imaging,MRI)对肛周化脓性汗腺炎( hidradenitis suppurativa,HS)诊断分期及治疗的临床应用价值。方法: 回顾性分析2018年1月至2020年12月就诊于包头医学院第二附属医院皮肤科及肛肠科的肛周HS患者的临床及MRI资料,结合临床Herley 分期,观察MRI显示的HS病灶分布与严重程度。结果: 10例患者中Herley Ⅰ期6例,Ⅱ期 4例,Ⅰ期患者MRI表现为局灶性炎症及脓肿,未见窦道。脓肿见于肛周(83 %),之后依次为臀区(50 %)、前会阴区(33 %)。Ⅱ期患者MRI表现为皮下组织炎症、脓肿及窦道,窦道未侵犯肌肉、肛管,未见窦道相互连接。4例患者中窦道见于肛周(100 %),前会阴区(25 %),臀区(25 %),坐骨直肠窝(25 %),臀沟(25 %)。脓肿见于肛周(100 %),前会阴区(50 %),臀区(50 %),坐骨直肠窝(25 %),臀沟(25 %)。本组患者MRI表现与临床分期一致。结论: MRI检查可明确肛周HS病变范围及深度,确定Herley 分期,为肛周HS的诊断、治疗及疗效判定提供客观的影像学依据。
Objective: To assess the value of application of magnetic resonance imaging in anogenital hidradenitis suppurativa. Methods: We collected the MRI images of patients diagnosed with HS in the department of Dermatology of the Second Affiliated Hospital of Baotou Medical Colledge between 2018.1 to 2020.12. The manifestations of clinical stage and MRI were analyzed and compared. Results: The 6 patients diagnosed with HS in Herley Ⅰpresented with inflamation and abcesses.The abcesses were seen in the perianal (83 %), the perineal(33 %),the gluteal(50 %).4 patients diagnosed with HS in Herley Ⅱpresented with sinuses and scar except inflamation and abcesses. The abcesses were seen in the perianal (100 %), the perineal(25 %),the gluteal(25 %), the natal cleft(25 %),the ischioanal fossa(25 %).The sinuses were seen in the perianal (100 %), the perineal(100 %),the gluteal(50 %),the natal cleft(25 %),the ischioanal fossa(25 %).No communication was found between anal canal and the abcesses or sinuses.The MRI feature was corresponding to the Herley stage. Conclusion: MRI can define the extent of HS which provide imaging evidence for treatment.
[1] 石继海,夏隆庆.化脓性汗腺炎的研究现状与治疗[J].国际皮肤性病学杂志,2007(1):2-3.
[2] 付琦,袁鹏,李春雨.肛周化脓性汗腺炎13例临床分析[J].中国普外基础与临床杂志,2016,23(8):995-997.
[3] 柴密,曾玮,杨红岩,等.化脓性大汗腺炎的手术治疗[J].中国美容医学,2018,27(9):45-48.
[4] Ovadja ZN, Schuit MM, Van Der Horst CMAM, et al. Inter- and intrarater reliability of Hurley staging for hidradenitis suppurativa[J]. Br J Dermatol, 2019, 181(2):344-349.
[5] Martorell A, Alfageme RoldáNF, Vilarrasa Rull E, et al. Ultrasound as a diagnostic and management tool in hidradenitis suppurativa patients: a multicentre study[J]. J Eur Acad Dermatol Venereol, 2019, 33(11): 2137-2142.
[6] 程静,赵云超,刘兴旺.肛门直肠周围脓肿及肛瘘MRI诊断(附45例报告)[J].医学影像学杂志,2017,27(2):302-305.
[7] Goldburg SR, Strober BE, Payette MJ. Hidradenitis suppurativa: epidemiology, clinical presentation, and pathogenesis[J]. J Am Acad Dermatol, 2020, 82 (5):1045-1058.
[8] 李小玲,罗观洋,王坚,等. 磁共振成像在复杂肛周感染诊断中的应用价值[J].现代医用影像学,2021,30(10):1884-1886.
[9] 中国反常性痤疮/化脓性汗腺炎诊疗专家共识制订小组.中国反常性痤疮/化脓性汗腺炎诊疗专家共识(2021版)[J].中华皮肤科杂志,2021, (2):97-104.
[10] 王天夫.肛周化脓性汗腺炎的诊疗方案探讨[J].中国烧伤创疡杂志,2017,29(5):348-350.
[11] 张莲,蔡卫东,孙希文. MRI肛瘘内口诊断在治疗中的价值:磁共振PDWI抑脂与增强T1WI抑脂序列的对照研究[J].中国医学计算机成像杂志,2016,22(5):435-439.
[12] 陈爱明,郭亮,钱伯源,等.皮肌炎磁共振成像诊断及其临床意义[J].中华皮肤科杂志,2000,33(1):44.
[13] 邢予,朱杏莉,杨希菊,等.磁共振成像不同扫描方位及序列对肛瘘诊断的价值[J].实用医学影像杂志,2015,16(6):533-535.