Zusammenfassung
Die Magnetresonanztomographie (MRT) in der Diagnostik anorektaler Fisteln und Abszesse hat sich in den letzten Jahren als Verfahren der ersten Wahl etablieren können. Die Vorteile liegen vor allem in der Nichtinvasivität und der sich davon ableitenden Patientenfreundlichkeit sowie der hohen Konkordanz der erhobenen Befunde mit der klinischen Realität. Die Bildgebung soll gerade im Falle dieser oft tabuisierten Erkrankung beitragen, das Risiko von Rezidiven, der Nichtheilung und Inkontinenz für die Patienten zu reduzieren. Dazu muss das bei dieser Fragestellung eingesetzte diagnostische Verfahren in der Lage sein, die hohen Anforderungen seitens der koloproktologisch tätigen Chirurgen zu erfüllen. Die MRT dient in diesem Kontext als Leitschiene für den Operateur, der das Ausmaß des Eingriffs anhand der Untersuchung exakt planen kann. Daneben wird diese Untersuchungstechnik für Patienten mit Morbus Crohn und anorektalen Fisteln in der Verlaufskontrolle eingesetzt. Im Jahr 2000 wurde die indirekte MR-Fistulographie als neues Untersuchungsverfahren eingeführt. In dieser Übersicht wird das Spektrum der Diagnostik anorektaler Fisteln beleuchtet mit besonderer Berücksichtigung der indirekten MR-Fistulographie.
Abstract
MRI is accepted as one of the major diagnostic tools for the detection of anorectal fistulas and abscesses. Noninvasiveness and high accuracy are advantageous hallmarks of this technique. In general, the purpose of imaging anal fistulas is to reduce the risk of recurrence, incontinence and non-healing. To achieve these goals, the applied method must provide the proctologist with detailed information. In this context, MRI acts as a guide for surgeons to accurately plan fistula operations. Another aspect is the follow-up of conservatively treated patients with fistulizing Crohn’s disease. In 2000, subtraction MR fistulography was introduced as new imaging technique. This review provides an overview of the entire spectrum of diagnostic modalities for anorectal fistulas with emphasis on subtraction MR fistulography.
Key words
Abscess - anal fistulas - Crohn’s disease - MR imaging - imaging techniques
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PD Dr. Arnd-Oliver Schäfer
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