TÀI LIỆU HỘI NGHỊ KỸ THUẬT ĐIỆN QUANG VÀ Y HỌC HẠT NHÂN VIỆT NAM LẦN 7 (2019) Nguồn: https://hinhanhykhoa.com/

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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 affects the health, living, labor,
psychology and quality of life of
patients

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MRI provides more accurate
information about :
INTRODUCTION
information about :
1. Anatomy of anal,
2. Internal anal sphincter and levator
i lani 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.
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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 protocolour 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.
• Examination after surgery anal fissure.g y

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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
to find the anal canal.

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INSTRUMENTS
TECHNIQUE
System MRI 1.5T
INSTRUMENTS
TECHNIQUE
• gadonilium.
• Cylinder 50ml +
sonde and gel.

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PATIENTS POSITIONING
• Head first supine
TECHNIQUE
• Head first supine.
• Fixed the body coil on pelvis.
• Center the laser over symphysis
pubispubis.
1. Localiser 3 planes( axial, sagital, coronal).
2. T2 TSE SAGITAL 3mm, F0V 180-200
3 T2 TSE CORONAL 3mm 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 AXIAL7. 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
gadolinium ( 6h -12h)

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• Sagital : parallel to
the shaft of the
BASIC SEQUENCES
the shaft of the
body, identify the
anal tube axis to
place the axial andplace the axial and
coronal
• Sagital : parallel to
the shaft of the
BASIC SEQUENCES
the shaft of the
body, identify the
anal tube axis to
place the axial andplace the axial and
coronal

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• Sagital : parallel to
the shaft of the
BASIC SEQUENCES
the shaft of the
body, identify the
anal tube axis to
place the axial andplace 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 theslices in front of the
symphysis pubis up
to the level of
sacrum.

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Pump gel, save sonde
to identify anal canal
BASIC SEQUENCES
to identify anal canal
clearly. the
relationship of fistula
with anal canalwith anal canal
structure, classify
fissure
• Axial : angle the
position block
BASIC SEQUENCES
position block
perpendicular to the
anal canal, cover the
whole buttock from
the mid rectum down
to the skin level of
buttock

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• Axial T2 TSE sequences:
It greatly values all
BASIC SEQUENCES
g y
anatomical structures. It
provides a contrast
between the cells
containing fat cells toco 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 toco g ce s o
increase the signal with
the weight-loss muscle
organization
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• Axial T2 TSE sequences:
It greatly values all
BASIC SEQUENCES
g y
anatomical structures. It
provides a contrast
between the cells
containing fat cells toco 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 toco g ce s o
increase the signal with
the weight-loss muscle
organization

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• Axial T2 TSE sequences:
It greatly values all
BASIC SEQUENCES
g y
anatomical structures. It
provides a contrast
between the cells
containing fat cells toco 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 toco g ce s o
increase the signal with
the weight-loss muscle
organization
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• Axial T2 TSE sequences:
It greatly values all
BASIC SEQUENCES
g y
anatomical structures. It
provides a contrast
between the cells
containing fat cells toco 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 toco g ce s o
increase the signal with
the weight-loss muscle
organization

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• 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
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• 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
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

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• DIFFUSION AXIAL
sequences: In
BASIC SEQUENCES
sequences: In
combination with T2-
weighted pulse chains,
it improves the
signaling of activesignaling 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 activesignaling of active
inflammatory leaks and
small abscesses
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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 infiltrationwell 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 aroundas the degree of infiltration around
the fistula.
 Allows analysis of activity levels of
inflammatory lesions, secondary
fistula and characteristics of
abscesses.

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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 infiltrationwell 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 infiltrationwell as the degree of infiltration
around the fistula.
 Allows analysis of activity levels
of inflammatory lesions,
secondary fistula and
characteristics of abscesses.
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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.
 Long exam time, on average 15-20 minutes, can cause
discomfort for patients.

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THANK FOR WATCHING
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