Advanced Diagnosis and New Findings Using MRI in the Treatment of Anorectal Diseases

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  • Ogawa Shimpei
    Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University
  • Itabashi Michio
    Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University
  • Yamamoto Masakazu
    Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University

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  • I．MRI検査による直腸肛門診療における診断の進歩（新しい知見）

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Abstract

MRI has high contrast resolution for soft tissues, such as adipose and muscle tissues, which allows the recording of various cross-sectional images. These images are useful for understanding anatomical relationships, and thus MRI is widely used for the diagnosis of anorectal diseases. For anal fistula of ischiorectal and pelvic rectal fossae, which are located in high and deep sites, evaluation with fat suppression T2-weighted images is useful. The location of a fistulous tract is difficult to detect, but expansion of an abscess can be easily visualized on MRI during surgery, and this method is useful for avoiding missing and insufficient treatment. For rectal and anal canal cancers, MRI is useful for evaluating the depth invasion and diagnosing lymph node metastasis, and also for evaluating the circumferential resection margin (CRM). MRI is also important for identifying risk factors for local recurrence and poor prognosis, and for evaluating the extent of a tumor in the anal canal, which determines the indication for intersphincteric resection (ISR) and the therapeutic strategy.<BR>DWI-MRI and USPIO-enhanced MRI using a lymph node-specific contrast agent have also been used as new diagnostic methods for lymph node metastasis and are likely to improve diagnostic accuracy.

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