目的:探讨多层螺旋CT（MSCT）平扫、增强并结合瘘管造影对肛瘘进行定位诊断的临床应用价值。方法:2004年7月至2006年5月间温州医学院附属第一医院对32例临床疑诊为肛瘘的病人使用16层螺旋CT扫描和瘘管造影。原始图像采用多平面重建（MPR）和容积重建（VR）技术进行三维重建，后处理图像由放射科专业医生完成。将术前获取的影像学资料与显微肛瘘手术和随访结果进行比较。结果:MSCT上4例未发现肛瘘，5例为单纯性肛瘘，23例为复杂性肛瘘,均经过手术证实，肛肠专科检查将8例复杂性肛瘘误诊为单纯性肛瘘。MSCT上低位肛瘘6例，高位肛瘘22例，均经过手术证实，其中肛肠专科检查将8例高位肛瘘误诊为低位肛瘘，MSCT上3例括约肌外瘘误诊为括约肌上瘘。MSCT对术前内口、支管、脓腔评价的准确率分别为62.1%、89.3%、100.0%。MSCT后处理重建技术中，MPR包括曲面重建（CPR）可清晰显示瘘管的具体位置及其与肛管内外括约肌、肛提肌的关系，VR能三维再现瘘管的形态和走行特点。结论:MSCT平扫、增强并结合瘘管造影是一种有效而可靠的对肛瘘进行定位诊断的检查方法，可以为手术提供有效依据。

Objective:To evaluate the effectiveness and applied value of multislice spiral computed tomography (MSCT) plain and enhanced scan combined with fistulography to the locational diagnosis of anal fistula. Methods:Preoperatively MSCT examination was performed in 32 patients with clinically suspected anal fistulas between July 2004 and May 2006 and results were compared with microsurgical and followup findings.Multiplanar reconstruction (MPR) and volume rendering (VR) were adopted to reconstruct 3D images in all cases.Images of MSCT were reviewed by professional radiologist. Results:On MSCT examination,4 patients had no fistula.Five patients had simple fistulas.Twenty-three patients had complex fistulas.All patients were confirmed by operation.At the same time 8 cases were misdiagnosed in surgery’s professional examination.Six patients had lowlocated fistulas.Twentytwo patients had highlocated fistulas.All patients were confirmed by operation,but on surgery’s professional examination 8 cases with highlocated fistulas were misdiagnosed as lowlocated fistulas.Three cases of extrasphincteric fistulas were misdiagnosed as suprasphincteric fistulas.For detection of the presence of internal openings,secondary tracts,abscesses,MSCT had a accuracy of 62.1％,89.3％,100.0%.The 3D shape and track of fistula could be well demonstrated by VR，while MPR including curved planar reconstruction (CPR) could well show the site of anal fistula and its relationship with the sphincter complex and the levator ani muscle. Conclusion:MSCT combined with fistulography is a very effective and reliable method for the locational diagnosis of anal fistula.