MRI appearance of perianal carcinoma in Crohn's disease

Abstract

Detection of carcinoma in perianal Crohn's disease can be difficult. The purpose of this study was to describe the MRI appearance of anorectal cancer in patients with perianal Crohn's disease. A total of six patients with anorectal carcinoma (four mucinous adenocarcinoma, two squamous) in Crohn's disease were retrospectively reviewed. Axial T2 and dynamic postcontrast fat‐suppressed T1‐weighted gradient echo sequences were performed, and findings were compared with 18 noncancer patients with perianal fistulae in Crohn's disease. MRI characteristics of carcinoma were irregular inner wall contours and delayed mild enhancement of internal tissue. The combined features of an irregular internal wall and delayed enhancing tissue were seen exclusively in cancer patients. The four cases of mucinous adenocarcinoma all displayed a pattern of lobulated fluid‐filled cavities with delayed internal tissue enhancement. This pattern was not seen in any of the control cases. The presence of a double‐layered enhancement pattern was seen in both cases of squamous carcinoma and in only one of four cases of mucinous adenocarcinoma and one of 18 noncancer cases. The pattern of contrast enhancement is valuable in the MRI diagnosis of carcinoma in perianal Crohn's disease. J. Magn. Reson. Imaging 2007. © 2007 Wiley‐Liss, Inc.

Cancer of the Anus Complicating Perianal Crohn's Disease

“…To date, MRI has only been able to differentiate active from inactive perianal disease, but this imaging modality may be useful in differentiating benign from malignant change in PCD. 39 In this series, cancer was not diagnosed in any of the patients who had MRI preoperatively. However, a retrospective review of the MRIs revealed features that may be suggestive of cancer.…”

“…These features are irregular inner wall contours and delayed mild enhancement of internal tissues. 39 Among these six patients with cancer complicating PCD who were compared with controls without cancer, changes suggestive of cancer were present only in the cancer patients. Furthermore, a mucinous pattern was only found in the four cases of mucinous adenocarcinoma.…”

“…Furthermore, a mucinous pattern was only found in the four cases of mucinous adenocarcinoma. 39 No previous reports have used MRI successfully for the diagnosis of carcinoma in PCD. Endorectal ultrasound and biopsy also should be performed where there is a change in signs and symptoms.…”

Gastrointestinal cancers in inflammatory bowel disease: An update with emphasis on imaging findings

“…The major role of MR imaging in the evaluation of perianal disease and for the staging of anal cancer is well established O'Malley et al, 2012;Schwartz et al, 2001;Torkzad and Karlbom, 2010;Horsthuis et al, 2009;Lad et al, 2007;Koh et al, 2008). In CD patient with anal or perianal carcinoma, MR imaging should be used to help guide surgeons for performing biopsies in suspicious areas (Torkzad and Karlbom, 2010).…”

“…In addition MR imaging allows differentiating between active and quiescent perianal disease (Koh et al, 2001) and assess response to therapy (Horsthuis et al, 2009). Although several authors have described the appearance of fistula-associated anal adenocarcinoma, the imaging appearance of anal cancer in CD patients has been reported scarcely (Devon et al, 2009;Lad et al, 2007;Yamaguchi et al, 2009;Yang et al, 2009;Tonolini and Bianco, 2013).…”