MR Imaging of Perianal Crohn Disease

Sheedy, Shannon P.; Dozois, Eric J.; Faubion, William A.; Fletcher, Joel G.

doi:10.1148/radiol.2016151491

Cited by 85 publications

(51 citation statements)

References 97 publications

(119 reference statements)

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“…Analysis of contrast enhancement has now clearly proven its interest in follow-up and characterization between inflammatory or fibrotic ileocolonic lesions[31,38]. Recent MRI sequences like diffusion or magnetization transfer could be used in the future for evaluation of patients under treatment[20,39,40]. Compared to our previous study, we found a higher (one third) rate of deep remission at 40 mo than at 12 mo (one quarter)[18].…”

Section: Discussionmentioning

confidence: 52%

“…It allows accurate morphological assessment to obtain information on perianal disease activity that can be used for follow-up[17-19]. Improvement in MRI techniques including 3 Tesla imaging and serial MRI examination have emerged as a standard to prepare, to guide and finally to gauge the success of treatment[20]. An MRI-based score (Van Assche) is available and uses different criteria to describe the anatomy (extension) and complexity (active inflammation, abscess) of the fistula[19,21].…”

Section: Introductionmentioning

confidence: 99%

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Magnetic resonance imaging may predict deep remission in patients with perianal fistulizing Crohn's disease

Thomassin¹,

Armengol-Debeir²,

Charpentier³

et al. 2017

WJG

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AIMTo evaluate the imaging course of Crohn’s disease (CD) patients with perianal fistulas on long-term maintenance anti-tumor necrosis factor (TNF)-α therapy and identify predictors of deep remission.METHODSAll patients with perianal CD treated with anti-TNF-α therapy at our tertiary care center were evaluated by magnetic resonance imaging (MRI) and clinical assessment. Two MR examinations were performed: at initiation of anti-TNF-α treatment and then at least 2 years after. Clinical assessment (remission, response and non-response) was based on Present’s criteria. Rectoscopic patterns, MRI Van Assche score, and MRI fistula activity signs (T2 signal and contrast enhancement) were collected for the two MR examinations. Fistula healing was defined as the absence of T2 hyperintensity and contrast enhancement on MRI. Deep remission was defined as the association of both clinical remission, absence of anal canal ulcers and healing on MRI. Characteristics and imaging patterns of patients with and without deep remission were compared by univariate and multivariate analyses.RESULTSForty-nine consecutive patients (31 females and 18 males) were included. They ranged in age from 14-70 years (mean, 33 years). MRI and clinical assessment were performed after a mean period of exposure to anti-TNF-α therapy of 40 ± 3.7 mo. Clinical remission, response and non-response were observed in 53.1%, 20.4%, and 26.5% of patients, respectively. Deep remission was observed in 32.7% of patients. Among the 26 patients in clinical remission, 10 had persisting inflammation of fistulas on MRI (T2 hyperintensity, n = 7; contrast enhancement, n = 10). Univariate analysis showed that deep remission was associated with the absence of rectal involvement and the absence of switch of anti-TNF-α treatment or surgery requirement. Multivariate analysis demonstrated that only the absence of rectal involvement (OR = 4.6; 95%CI: 1.03-20.5) was associated with deep remission.CONCLUSIONDeep remission is achieved in approximately one third of patients on maintenance anti-TNF-α therapy. Absence of rectal involvement is predictive of deep remission.

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Section: Discussionmentioning

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging may predict deep remission in patients with perianal fistulizing Crohn's disease

Thomassin¹,

Armengol-Debeir²,

Charpentier³

et al. 2017

WJG

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“…Perianal fistulas are the most common perianal manifestation of Crohn's disease, with a prevalence up to 27% . Patients with colonic and rectal Crohn's involvement are at the highest risk for perianal fistula development .…”

Section: Pathologic Conditions Of the Anal Canalmentioning

confidence: 99%

“…Perianal fistulas may be the initial manifestation of Crohn's disease in about 20% of patients; therefore, detection of a complex perianal fistula should raise a possibility of Crohn's disease even in the absence of the established diagnosis. Perianal fistulas in patients with Crohn's disease are often more complex than those occurring in the general population, and are more likely to have secondary fistulas, sinus tracts, and abscesses …”

Section: Pathologic Conditions Of the Anal Canalmentioning

confidence: 99%

“…MRI plays a key role in assessing the extent of perianal fistulas in patients with Crohn's disease due to its ability to accurately detect secondary abscesses or tracts that may be surgically occult or need drainage prior to immunosuppressive treatment (Fig. ) . Additionally, an MRI‐based score for severity of perianal fistulas, which takes into account the number of tracts, their location with respect to the IAS, EAS, and levator ani muscles, degree of hyperintensity on T 2 ‐weighted images, the presence of concomitant abscesses >3 mm in diameter, and the presence of rectal wall involvement, serve as an imaging biomarker for monitoring response to therapy .…”

Section: Pathologic Conditions Of the Anal Canalmentioning

confidence: 99%

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MRI anatomy and pathology of the anal canal

Erlichman

Kanmaniraja

Kobi

et al. 2019

Magnetic Resonance Imaging

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The normal function of the anal sphincter complex is crucial for quality of life, as it is the mechanism by which fecal continence is maintained. Additionally, the anal sphincter complex is an integral part of the coordinated effort of defecation. As imaging plays an important role in assessment of pathologic conditions involving the anal region, understanding the normal anatomy of the anal sphincter complex is important for correct image interpretation and accurate diagnosis. This review discusses the anatomy and function of the anal sphincter complex, important technical considerations for MRI, and various inflammatory, infectious, and neoplastic processes, as well as pathologic structural conditions that affect the anal region. Level of Evidence: 5 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2019;50:1018–1032.

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Management of Hospitalized Patients with Fistulizing Crohn’s and Crohn’s-Related Abscess

Chibbar

Flier

2021

Management of Inpatient Inflammatory Bowel Disease

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MR Imaging of Perianal Crohn Disease

Cited by 85 publications

References 97 publications

Magnetic resonance imaging may predict deep remission in patients with perianal fistulizing Crohn's disease

Magnetic resonance imaging may predict deep remission in patients with perianal fistulizing Crohn's disease

MRI anatomy and pathology of the anal canal

Management of Hospitalized Patients with Fistulizing Crohn’s and Crohn’s-Related Abscess

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