angle the position block perpendicular to the anal canal, The pulse sequence is very valuable in the case of a small leak, which is difficult to. observe on the T2W pulse[r]
(1)Bui Thanh Cao Nguyen Huu Tuan Nguyen Manh Linh*
MRI TECHNIQUES ANAL FISSURE
Bui Thanh Cao, Nguyen Huu Tuan, Nguyen Manh Linh (*) RADIOLOGY DEPARTMENTS, VIET DUC HOSPITAL
Anal fissure:
Anal fissure is an inflammation around
INTRODUCTION
Anal fissure is an inflammation around the anus.
less dangerous to life
ff t th h lth li i l b
(2)2
MRI provides more accurate information about :
INTRODUCTION
information about :
1. Anatomy of anal,
2. Internal anal sphincter and levator
i l
ani muscle
3. The relationship between the fissure with anal canal structure.
MRI accurately identifies fistula or abscess
INTRODUCTION
abscess.
MRI give a main role in exam the anal fissure before and after treatment.
(3)In Viet Đuc hospital, average 50 patients/month who has indicated a INTRODUCTION
patients/month who has indicated a MRI of anal fissure.
We base on the actual situation at
our hospital and set a protocol our hospital and set a protocol
examination: There is a sonde set and
pump gel into the rectum to create contrast.
TECHNIQUE
INDICATION
• Anal fissure.
• Test anal fissure, abscess anal.
(4)4 TECHNIQUE
CONTRAINDICATIONS
A l t i ll ti ll
• Any electrically, magnetically or
mechanically activated
• Metal in area of pelvis ( unless made
f tit i )
of titanium)
• patients with carpal tunnel syndrome.
• Allergy to gadolinium.
TECHNIQUE
PATIENT PREPARATION
• Explain the tricks to prepare
• Explain the tricks to prepare.
• Pump 10-20 ml gel rectal, save sonde
(5)INSTRUMENTS
TECHNIQUE System MRI 1.5T
INSTRUMENTS
TECHNIQUE
• gadonilium.
(6)6
PATIENTS POSITIONING
• Head first supine
TECHNIQUE
• Head first supine.
• Fixed the body coil on pelvis. • Center the laser over symphysis
pubis pubis.
1 Localiser planes( axial, sagital, coronal)
2 T2 TSE SAGITAL 3mm, F0V 180-200
3 T2 TSE CORONAL3mm FOV 180 200
BASIC SEQUENCES
3 T2 TSE CORONAL 3mm, FOV 180-200
4 T2 TSE AIXAL 3mm, FOV 180-200
5 T2 TSE AXIAL FS ( STIR) 3mm, FOV 180-200
6 T2 TSE CORONAL FS ( STIR), 3mm FOV 180-200
7 DIFFUSION AXIAL
7 DIFFUSION AXIAL
8 T1 SE AXIAL FS 3mm, FOV 180-200 before and after
gadolinium
9. T1 SE SAGITAL FS 3mm, FOV 180-200 before and after
(7)• Sagital : parallel to
the shaft of the
BASIC SEQUENCES the shaft of the
body, identify the anal tube axis to place the axial and place the axial and coronal
• Sagital : parallel to
the shaft of the
BASIC SEQUENCES the shaft of the
(8)8
• Sagital : parallel to
the shaft of the
BASIC SEQUENCES the shaft of the
body, identify the anal tube axis to place the axial and place the axial and coronal
Coronal : parallel to the anal tube axis
BASIC SEQUENCES the anal tube axis,
cover the whole buttock from two slices in front of the slices in front of the symphysis pubis up to the level of
(9)Pump gel, save sonde to identify anal canal
BASIC SEQUENCES to identify anal canal clearly the
relationship of fistula with anal canal
with anal canal structure, classify fissure
• Axial : angle the
position block
BASIC SEQUENCES
position block
(10)10
• Axial T2 TSE sequences:
It greatly values all
BASIC SEQUENCES
g y
anatomical structures It provides a contrast
between the cells containing fat cells to
co g ce s o
increase the signal with the weight-loss muscle organization
• Axial T2 TSE sequences:
It greatly values all
BASIC SEQUENCES
g y
anatomical structures It provides a contrast
between the cells containing fat cells to
co g ce s o
increase the signal with the weight-loss muscle organization
(11)• Axial T2 TSE sequences:
It greatly values all
BASIC SEQUENCES
g y
anatomical structures It provides a contrast
between the cells containing fat cells to
co g ce s o
increase the signal with the weight-loss muscle organization
• Axial T2 TSE sequences:
It greatly values all
BASIC SEQUENCES
g y
anatomical structures It provides a contrast
between the cells containing fat cells to
co g ce s o
(12)12
• Axial T2 TSE sequences:
It greatly values all
BASIC SEQUENCES
g y
anatomical structures It provides a contrast
between the cells containing fat cells to
co g ce s o
increase the signal with the weight-loss muscle organization
• Axial T2 TSE sequences:
It greatly values all
BASIC SEQUENCES
g y
anatomical structures It provides a contrast
between the cells containing fat cells to
co g ce s o
increase the signal with the weight-loss muscle organization
(13)• Axial T2 TSE sequences:
It greatly values all
BASIC SEQUENCES
g y
anatomical structures It provides a contrast
between the cells containing fat cells to
co g ce s o
increase the signal with the weight-loss muscle organization
• Axial T2 TSE sequences:
It greatly values all
BASIC SEQUENCES
g y
anatomical structures It provides a contrast
between the cells containing fat cells to
co g ce s o
(14)14
• T2 TSE FATSAT AXIAL
angle the position block
BASIC SEQUENCES angle the position block
perpendicular to the anal canal, The pulse sequence is very valuable in the case of a small leak, which is difficult to observe on the T2W pulse sequence
• T2 TSE FATSAT
AXIAL
BASIC SEQUENCES AXIAL
angle the position block perpendicular to the anal canal, The pulse sequence is very valuable in the case of a small leak, which is difficult to
observe on the T2W pulse
(15)• T2 TSE FATSAT AXIAL
angle the position block
BASIC SEQUENCES angle the position block
perpendicular to the anal canal, The pulse sequence is very valuable in the case of a small leak, which is difficult to observe on the T2W pulse sequence
• T2 TSE FATSAT AXIAL
angle the position block
BASIC SEQUENCES angle the position block
(16)16
• DIFFUSION AXIAL sequences: In
BASIC SEQUENCES
sequences: In
combination with T2-weighted pulse chains, it improves the
signaling of active signaling of active
inflammatory leaks and small abscesses
• DIFFUSION AXIAL sequences: In
BASIC SEQUENCES
sequences: In
combination with T2-weighted pulse chains, it improves the
signaling of active signaling of active
inflammatory leaks and small abscesses
(17)T1 SE FS and T1 SE FS + GADOLINIUM
BASIC SEQUENCES
Evaluate the level of drug penetration of the fistula,
Clearly distinguish the internal sphincter, external sphincter as well as the degree of infiltration well as the degree of infiltration around the fistula
Allows analysis of activity levels of inflammatory lesions,
secondary fistula and characteristics of abscesses
T1 SE FS and T1 SE FS + GADOLINIUM
BASIC SEQUENCES
Evaluate the level of drug penetration of the fistula,
(18)18
T1 SE FS and T1 SE FS + GADOLINIUM
BASIC SEQUENCES
Evaluate the level of drug penetration of the fistula,
Clearly distinguish the internal sphincter, external sphincter as well as the degree of infiltration well as the degree of infiltration around the fistula
Allows analysis of activity levels of inflammatory lesions,
secondary fistula and characteristics of abscesses
T1 SE FS and T1 SE FS + GADOLINIUM
BASIC SEQUENCES
Evaluate the level of drug penetration of the fistula,
Clearly distinguish the internal sphincter, external sphincter as well as the degree of infiltration well as the degree of infiltration around the fistula
Allows analysis of activity levels of inflammatory lesions,
secondary fistula and characteristics of abscesses
(19)1 ADVANTAGES
Pump the gel and save sonde into the rectum helps us
DISCUSION
p g p
determine the exact anal canal axis, take sequences parallel or perpendicular to the anal canal easily and exactly
Select high resolution pulse sequences(SE, TSE ), small FOV (180-200), thin slice thickness(3mm)
helped doctor found location, relationship of fistula, determine the degree of fistula better, more effective treatment
2 DEFECT
Difficulty to pump gel in rectum with young patients
DISCUSION
Difficulty to pump gel in rectum with young patients, uncooperative or the patient is swollen with anus
(20)20 THANK FOR WATCHING
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